Health and Medicine – Page 19

Revisiting Chernobyl

chernobyl-nuclear-power-plant Chernobyl. The very name strikes fear into the hearts of those who hate everything about the nuclear industry. It conjures up images of an archaic, burning industrial site spewing out lethal fumes, of farm animals dying of radiation poisoning in their thousands and contaminated meat, of ecosystems devastated, and of people with radiation sickness and for those spared the acutely fatal toxicity, the prospect of cancers to come and perhaps generations of mutations. But…

Korean researchers argue that while the 1986 accident at the Chernobyl nuclear power plant, Ukraine, was the worst catastrophe involving radiation to humans, but has led to an unfortunate and unwarranted degree of radio-anxiety. It is not radiation that is the health issue, but this anxiety.

Chong-Soon Kim of the Korea Institute of Radiological and Medical Sciences and colleagues say that despite warnings of pent up health problems from Greenpeace and the World Health Organisation (WHO), “there is no convincing evidence that the incidence of leukaemia or solid cancers have increased in the exposed populations.” They add that the apparent evidence of decreased fertility and increased hereditary effects has not been observed in the general population despite claims to the contrary.

According to the WHO, some 4000 people – emergency workers and residents – died or could die in the future because of Chernobyl. Greenpeace insists that this figure is almost 100,000 across the globe. Kim and colleagues point out first that although the incidence of thyroid cancer has increased in the Chernobyl area, it is actually regions less contaminated by radiation where the greatest incidence has been reported.

“In this case we have to be cautious on the point that the results came from extrapolation using insufficient individual doses, and so far deaths from cancer have not been reported as predicted,” say Kim and colleagues.

The radiation exposure level is the most important factor to estimate the cancer risk due to the Chernobyl accident. There are three types of exposed people. First, the exposure of recovery operation workers ranged up to about 500 millisieverts for a short period after the accident, with an average of about 100 mSv. In the case of evacuees, the average dose estimate of Ukrainian evacuees is 17 mSv (range 0.1-380 mSv), and the estimate for the Belarusian evacuees is 31 mSv, with a maximum of about 300 mSv. The average effective dose estimate of the general population in contaminated areas from 1986 to 2005 (some 5 million people) is 10-20 mSv.

The impact of Chernobyl on mental health and the future of nuclear as a viable renewable energy industry with public support, is perhaps the most serious problem. Among residents of the region and the emergency workers major psychological problems, such as depression, anxiety, and post-traumatic stress disorder are common. Anxiety levels are reported to be twice as high as in controls, the researchers say.

“Health effects, including cancer deaths, due to the Chernobyl accident have not reached the serious situation that was predicted,” the researchers say. There is, of course, some uncertainty in these figures although solid cancers usually form over a fifteen year period, rather than twenty years.

Young Woo Jin, Meeseon Jeong, Kieun Moon, Kwang Hee Yang, Byung Il Lee, Hun Baek, Sang Gu Lee, Chong Soon Kim (2008). Health effects 20 years after the Chernobyl accident International Journal of Low Radiation, 5 (3) DOI: 10.1504/IJLR.2008.020255

Melamine in Milk

melamine-structure-3D UPDATE: Melamine Milk Update, January 22, 2009

Sciencebase will be keeping you updated on the melamine scandal with opinion from the experts and the latest news on the story as it unfolds.

Several thousand babies in China became ill, having apparently suffered acute kidney failure, with several fatalities, having been fed formula milk allegedly contaminated with the industrial chemical melamine. The toll is far higher than was previously admitted by the Chinese authorities, according to the BBC. Click here for a list of melamine contaminated products.

One manufacturer recalled all of its powdered milk products in China’s north-west province of Gansu. However, twenty-two brands of milk powder were quickly identified as containing melamine. “The majority of afflicted infants ingested [the] milk powder over a long period of time, their clinical symptoms showed up three to six months after ingesting the problematic products,” Health Minister Chen Zhu told Bloomberg Asia.

Allegedly, someone in the supply change, milk supplier or manufacturer, was adding melamine to the milk formula to artificially inflate the reading for protein levels. Formula milk was not until now tested for melamine, because regulators did not suspect this ingredient might be added. But, it turns out that melamine in the food supply is China’s big open secret.

So, what is melamine and how does it spoof the protein levels in baby formula milk?

melamine-structure Melamine is an organic compound, a base with the formula C₃H₆N₆. Officially it is 1,3,5-triazine-2,4,6-triamine in the IUPAC nomenclature system (CAS #108-78-1). It is has a molecular mass of just over 126, forms a white, crystalline powder, and is only slightly soluble in water. It is used in fire retardants in polymer resins because its high nitrogen content is released as flame-stifling nitrogen gas when the compound is burned or charred.

Indeed, it is this high nitrogen level – 66% nitrogen by mass – in melamine that gives it the analytical characteristics of protein molecules. Melamine can also be described as a trimer of cyanamide, three cyanamide units joined in a ring. It is described as being harmful according to its MSDS sheet: “Harmful if swallowed, inhaled or absorbed through the skin. Chronic exposure may cause cancer or reproductive damage. Eye, skin and respiratory irritant.” Not something you would want in your infant’s milk. However, that said, the toxic dose is rather high, on a par with common table salt with an LD50 of more than 3 grams per kilogram of bodyweight.

Previously, melamine was found in exported pet food last year and blamed for killing thousands of cats and dogs in the US. Bloomberg also reports that analysis of samples of ice cream produced by one company have also revealed the presence of melamine. Regardless of crushing inflation and legislative pressure, there is no excuse for the adulteration of food in this way. Diluting a product, the previous approach, is highly unethical and can lead to malnutrition, but straight poisoning is tantamount infanticide. This is also not the first time that Chinese consumers have faced problems with milk powder. In 2004, more than a dozen children died having been fed formula with minimal nutritional content.

But, if melamine has low toxicity (hat tip to commenter Barney) then what is it that has poisoned thousands of babies in China and why has this scandal occurred? Well, LD50, the toxic dose issue, tells us something about acute exposure not the apparent six-months’ worth of accumulated exposure these babies have suffered. Chronic exposure to melamine can lead to bladder or kidney stones and even bladder cancer and as we have learned, acute kidney failure. Health problems such as these can land you in the hospital. Most treatments cannot be given at home, therefore you will not have the comfort of your couch or bed. Many hospitals do not have the luxury of offering ergo mattresses to their patients.

The melamine in milk headlines also ignore the fact that the compound added to the milk may not be pure. There is no reason to imagine that those unscrupulous enough to add a toxic compound to baby formula milk would worry about contaminants, such as cyanuric acid, that might be found in the raw material. Indeed, even if melamine toxicity were not an issue and truly was an inert substance added to spike the protein readings in quality control tests, then any one of the impurities associated with rough melamine manufacture may be a major cause for concern.

UPDATES: A melamine apology from the Chinese premier, Melamine Scandal Widens and Milky Melamine, melamine and kidney failure.

Sex and Social Networking

Ultimately, the only truly safe sex is that practised alone or not practiced at all, oh, and perhaps cybersex. However, that said, even these have issues associated with eyesight compromise (allegedly), repetitive strain injury (RSI) and even electrocution in extreme cases of online interactions (you could spill your Mountain Dew on your laptop, after all). And, of course, there are popups, Trojans, packet sniffers and viruses and worms to consider…

No matter how realistic the graphics become in Second Life or how good the 3rd party applications in Facebook, however, unless you indulge in direct human to human contact in the offline world, you are not going to catch a sexually transmitted disease, STD. Real-world social networking is, of course, a very real risk factor for STD transmission, according to a new research report in the International Journal of Functional Informatics and Personalised Medicine. This could be especially so given the concept of ~~six~~ five-degrees of separation through which links between individuals are networked by ever short person-to-person-to-person bonds.

According to Courtney Corley and Armin Mikler of the Computational Epidemiology Research Laboratory, at the University of North Texas, computer scientist Diane Cook of Washington State University, in Pullman, and biostatistician Karan Singh of the University of North Texas Health Science Center, in Fort Worth, sexually transmitted diseases and infections are, by definition, transferred among intimate social networks.

They point out that although the way in which various social settings are formed varies considerably between different groups in different places, crucial to the emergence of sexual relationships is obviously a high level of intimacy. They explain that for this reason, modelling the spread of STDs so that medical workers and researchers can better understand, treat and prevent them must be underpinned by social network simulation.

Sexually transmitted diseases and infections are a significant and increasing threat among both developed and developing countries around the world, causing varying degrees of mortality and morbidity in all populations.

Other research has revealed that approximately one in four teens in the United States will contract a sexually transmitted disease (STD) because they fail to use condoms consistently and routinely. The reasons why are well known it seems – partner disapproval and concerns of reduced sexual pleasure.

As such, professionals within the public health industry must be responsible for properly and effectively funding resources, based on predictive models so that STDs can be tamed. If they are not, Corley and colleagues suggest, preventable and curable STDs will ultimately become endemic within the general population.

The team has now developed the Dynamic Social Network of Intimate Contacts (DynSNIC). This program is a simulator that embodies the intimate dynamic and evolving social networks related to the transmission of STDs. They suggest that health professionals will be able to use DynSNIC to develop public health policies and strategies for limiting the spread of STDs, through educational and awareness campaigns.

As a footnote to this research, it occurred to me that researchers must spend an awful lot of time contriving acronyms and abbreviations for their research projects. Take Atlas, one of the experimental setups at the Large Hadron Collider at CERN in Geneva Switzerland. Atlas stands for – “A Toroidal LHC ApparatuS”. So they used an abbreviation within their acronym as well as a noise word – “A” and the last letter of one of the terms. Ludicrous.

But, Atlas is not nearly as silly as the DynSNIC acronym used in Corley’s paper, I’m afraid. Dynamic Social Network of Intimate Contacts, indeed! I thought the whole idea of abbreviating a long research project title was to make it easier to remember and say out lead. DynSNIC, hardly memorable (I is it a y or an I, snic or snick or sink or what. Students will forever struggle with such contrivances. They could’ve just as easily used something like Sexually Transmitted Infections Contact Social Intimate Networks – STICSIN. This would be a double-edged sword that would appeal to both to the religious right and to the scabrous-minded, depending where you put the break (after the Contact or after Social.

Courtney D. Corley, Armin R. Mikler, Diane J. Cook, Karan P. Singh (2008). Dynamic intimate contact social networks and epidemic interventions International Journal of Functional Informatics and Personalised Medicine, 1 (2), 171-188

Bird Flu Flap

Bird flu duck I’m not entirely convinced that bird flu (avian influenza) is going to be the next big emergent disease that will wipe out thousands, if not millions, of people across the globe. SARS, after all, had nothing to do with avians, nor does HIV, and certainly not malaria, tuberculosis, MRSA, Escherichia coli O157, or any of dozens of virulent strains of disease that have and are killing millions of people.

There are just so many different types of host within which novel microbial organisms and parasites might be lurking, just waiting for humans to impinge on their marginal domains, to chop down that last tree, to hunt their predators to extinction, and to wreak all-round environmental habitat on their ecosystems, that it is actually only a matter of time before something far worse than avian influenza crawls out from under the metaphorical rock.

In the meantime, there is plenty to worry about on the bird flu front, but perhaps nothing for us to get into too much of a flap over, just yet.

According to a report on Australia’s ABC news, researchers have found that the infamous H5N1 strain of bird flu (which is deadly to birds) can mix with the common-or-garden human influenza virus. The news report tells us worryingly that, “A mutated virus combining human flu and bird flu is the nightmare strain which scientists fear could create a worldwide pandemic.”

Of course, the scientists have not discovered this mutant strain in the wild, they have simply demonstrated that it can happen in the proverbial Petri dish.

Meanwhile, bootiful UK turkey company – Bernard Matthews Foods – has called for an early warning system for impending invasions of avian influenza. A feature in Farmers Weekly Interactive says the company is urging the government and poultry industry to work together to establish an early warning system for migratory birds that may carry H5N1 avian flu. “Armed with this knowledge, free range turkey producers would be able to take measures to avoid contact between wild birds and poultry.” That’s all well and good, but what if a mutant strain really does emerge that also happens to be carried by wild (and domesticated birds) or, more scarily by another species altogether? Then, no amount of H5N1 monitoring is going to protect those roaming turkeys.

While all this is going on, the Washington Post reports that the Hong Kong authorities announced Wednesday (June 10) that they are going to cull poultry in the territory’s retail markets because of fears of a dangerous bird flu outbreak. H5N1 virus was detected in chickens being sold from a stall in the Kowloon area and 2700 birds were slaughtered there to prevent its spread. In closely related news, the International Herald Tribune has reported that there has been an outbreak of bird flu in North Korea. “Bird flu has broken out near a North Korean military base in the first reported case of the disease in the country since 2005, a South Korean aid group said Wednesday.” But, note, “since 2005”, which means it happened before, and we didn’t then see the rapid emergence of the killer strain the media scaremongers are almost choking to see.

Finally, the ever-intriguing Arkansas Democrat Gazette reported, with the rather uninspiring headline: Test shows bird flu in hens. Apparently, a sample from a hen flock destroyed near West Fork, Arkansas, tested positive for avian influenza. A little lower down the page we learn that the strain involved is the far less worrisome H7N3. So, avian influenza is yet to crack the US big time. Thankfully.

Giving Obesity the CHOP

Obesity news I am once again drawn to research from a team at the University of Westminster, a renowned institution that doles out so-called science degrees in homeopathy. This time the paper in question, published in the inaugural issue of the International Journal of Food Safety, Nutrition and Public Health (2008, vol 1, issue 1, pp 16-32) is on that perennial favourite: what to do about the obesity epidemic.

Ihab Tewfik, a senior lecturer in the School of Biosciences, at Westminster, reports that “the prevalence and severity of people suffering from obesity has increased markedly worldwide,” and adds that “The WHO declared obesity a ‘crisis of epidemic proportion’.” Nothing of which I can be too critical in those statements, except for one small point.

While obesity and the diseases and disorders for which it is purportedly a risk factor – type II diabetes, hypertension, hyperlipidemia, atherosclerosis, cardiovascular disease, stroke, and heart attack – are almost certainly on the increase in North America, Western Europe, and pockets of the Pacific Rim, the use of the term “worldwide” is rather ironic. This is especially true given that the WHO and other international organizations consistently report massive cases of disease, malnourishment and poor water supply across great tracts of the earth’s surface from Africa and South America to Asia and the former Soviet Union.

Anyway, Tewfik and colleagues have proposed a conceptual framework for a three-year intervention programme that could be adapted to the prevention of childhood obesity, which is a growing problem in many parts of the world, if not quite worldwide.

Ironically, they have named the framework, with one of those shoehorned acronyms, as CHOP, for Childhood Obesity Prevention and explain their approach as follows:

The approach is based on a behaviour modification model without giving foods. Family, school and children are essential counterparts to achieve meaningful improvement. Advocated by policies makers and embraced with favourite environmental factors, CHOP programme could be the conceptual framework for nutrition intervention that can be effectively integrated within the national health framework to attain public health goals.

Apparently, what this boils down to is giving children healthy foods, increasing physical activity and workout limits, limited TV and other screen times, implementing a non-food reward system, and allowing self-monitoring. As part of this approach schools will intervene in teaching children that they should eat five portions of fruit and vegetables each day, that they should cut the amount of fat they eat, limit their screen time and be active every day.

It all sounds like good, solid advice. Indeed, it’s the kind of advice the medical profession, nannyish governments, and even grandparents, have been offering for decades. Unfortunately, growing children are notoriously reluctant to take advice, especially when it comes to avoiding sweets and crisps, eating their greens, and switching off the Playstation (other gaming consoles are available).

The Westminster researchers, however, suggest their CHOP system would be convenient once the appropriate team, policies and resources have been successfully assembled. One has to wonder at a cost to whom these resources might be assembled. They do concede that, “In some circumstances this conceptual framework may be regarded to be too ambitious to attempt de novo within three years especially in some developing countries, where lack of access to health care, to drinkable water, to food, to education and housing is prevalent.”

It’s probably not necessary to implement it in places where food is in limited supply, surely. But, even in apparently developed nations, I’d suggest that costs will be severely prohibitive while children will be reluctant to partake (what positive rewards will replace treats and screen time?). Moreover, by their own admission, obesity is on a rapid climb among adults too and one has to wonder how these resources will be applied to persuade parents and carers of increasingly obese children will themselves be persuaded to take part if they do not appreciate the potential benefits.

Tewfik, I. (2008). Childhood Obesity Prevention (CHOP) programme: a conceptual framework for nutrition intervention. International Journal of Food Safety, Nutrition and Public Health, 1(1), 16. DOI: 10.1504/IJFSNPH.2008.018853

Alcohol Causes Cancer

It’s quite illuminating that the following study has not yet reached the wider media. Without wishing to be too cynical, I do wonder whether that’s because the journal in which the work is published does not use a highly aggressive press office and marketing machine like so many other medical journals, which never seem to be out of the news. The results in this paper are just as important and the implications perhaps even more far reaching than many other results that attract instantaneous (under embargo) media attention. Anyway, take a look and judge for yourself, oh and let me know afterwards if you think the headline for this post is way off mark.

Alcohol blamed for oral cancer risk – A large-scale statistical analysis of mouth and throat cancer incidence over a long period of time has looked at possible correlations between exposure to industrial chemicals, dust and alcoholic beverages in a wide variety of individuals in different occupations across Finland. The perhaps surprising conclusion drawn is that alcohol consumption rather than industrial chemicals or dusts is the critical factor associated with this form of cancer. Get the full story in this week’s edition of my SpectroscopyNOW column here.

I suppose it’s a little ironic that in the same edition of Spec Now, I’m also writing about how to make beer taste fresher and last longer on the shelf. NMR spectroscopy, and a chromatography sniff test have yielded results that could help brewers improve the flavour and shelf-life of beer thanks to work by scientists in Venezuela. The team has identified alpha-dicarbonyls as important compounds that reduce beer’s flavour and point to a new approach to brewing beer that stays fresher, longer. Take a sip here…

Meanwhile, another subject of mixed messages regarding health benefits is that perennial favourite chocolate. To maintain the seductive and lustrous brown gloss of chocolate, so enticing to chocoholics the world over, food technologists must find a way to prevent fat bloom from forming on the surface and turning the surface an unappealing grey. Now, scientists from Canada and Sweden have found new clues to understanding the microstructure of chocolate and what happens when it turns grey with age. More…

Finally, some straight chemistry with absolutely no hint of biomedicine, health, or pharmaceutical implications (yet). A novel structure studied using X-ray crystallography hints at the possibility of a carbon atom that, at first site seems to be a little different from the conventional textbook view. Could the oldest rule of organic chemistry have been broken at last, or is low atomic separation being equated too keenly with the presence of a bond, or could there be something else afoot, as Steve Bachrach suggests? Read on…

Vital Signs

Homeopathy rVita emailed me today to enthuse about a purportedly “wonderful resource”, which is apparently the web’s first integrative medicine community (funny they should claim that as I had someone else emailing to tell me yesterday about their first such site too).

Anyway, I checked out the site, and am very, very disappointed, the first article I read was wrong, wrong, wrong. Homeopathy is most certainly not a viable alternative to vaccination against lethal diseases like polio, tetanus, and measles. To claim otherwise is not only seriously misleading but incredibly dangerous.

We’ve discussed some of the supposed issues surrounding possible problems with conventional vaccines here before, but homeopathy cannot prevent anyone from contracting such serious illness. No matter how hard followers of Hahnemann’s idea that diluting a substance repeatedly until absolutely none of the original compound remains in one’s vial and all the while repeatedly bashing the vial against a Bible believe it to work, it does not.

There is no valid, reproducible evidence of the efficacy of homeopathy as prophylaxis for serious disease where a vaccine would usually be used to prevent infection. The rVita article claims:

“Based on principles of natural law, you can receive protection against the flu or any disease including polio, tetanus, and measles by natural immunity.”

Seriously, there is no scientific basis nor evidence for any of the claims of homeopaths, particular with regard to prophylaxis against lethal diseases. This is as true in National Homeopathy Week as at any other time of the year.

rVita originally suggested the site would be “wonderful resource for any upcoming articles you might be planning on alternative or integrative medicine, Health 2.0, health resources on the Internet, or any other health-related topics,” well it does provide fodder for my highlighting some of the sillier claims of alt med.

Apparently, for users of the rVita community, “whether researching alternative remedies for allergies, infertility, insomnia, chronic pain or even adjunctive care for cancer, users can turn to rVita for help in separating the science from the snake oil.”

Hmmm…as well as the unfounded case of homeopathy, they also discuss Reiki therapy, therapeutic touch, art therapy and the like. Beyond, the placebo effect (which is admittedly very powerful) none of these or many other alternative therapies have any basis in reality

The exceptions, of course, are some herbal remedies. After all, a large proportion of modern drugs from aspirin and AZT to ephedrine and taxol are based on natural products. And some of the manipulating methods such as osteopathy and chiropractic, while dubious in their origins and some of their wider claims, do have physical effects. I was discussing such matters as the claims of chi, energy fields and auras with a colleague in the telecommunications industry who asked, scathingly, “In what units is this universal energy measured?” It’s a rather insightful put down.

Meanwhile, Niteen Bhat Founder CEO of rVeda Inc, of Santa Clara, California, and parent company of the rVita website, contacted me in response to my email respone to their approach. This is what he had to say:

I just wanted to highlight a few things about our philosophy to present our side of the story: Our goal is to bring perspectives from both for “for” and “against” constituents for a particular therapy or modality to enable informed decision making and separate science from snake oil. We welcome experts such as yourself to either comment on any article or even write your own articles that highlight issues with any remedy. That’s the power of Web 2.0 that we are unleashing on CAM.

Having said that, consumers and integrative medicine folks are finding some of these therapy to be effective even though scientific trials are inconclusive or not done yet. One of the reason being that many CAM therapies take personalized medicine approach and essentially have slightly different variants of therapies for each individual. This is exactly the reason we currently do not promote product sales, or do-it-yourself therapies, but expect consumers to get healed via licensed CAM practitioners.

Our content is overseen by conventional medicine MDs (I have copied our Chief Medical Advisor on this email). We did discuss the issues raised and came to [the] conclusion that we need to highlight practitioner articles as such so that we keep sanctity of our select/carefully chosen experts and their opinions. We have decided to separate practitioner articles under separate categories.

So, my review of their site has had a rather positive effect, but efforts to dry up supplies of snake oil must continue.

Many commentators will not accede to using words such as “complementary” or “integrated” to refer to alternative medicine, the name change falls into the same camp as switching from “creationism” to “intelligent design”, as far as I am concerned. Show me the evidence in the form of large-scale, robust, placebo-controlled, double or even triple, blind, clinical trials, however, not spurious poorly controlled tests and selective meta studies, and I’m a believer.

If it produces a sound akin to that of the aquatic avian species falling under the taxonomic name Anas platyrhynchos platyrhynchos, then it really is best avoided, especially if you wish to stay free of lethal diseases.

For an excellent summary of alternative medicine the fact and the fiction, check out Singh and Ernst’s book Trick or Treatment

A Chilli Gut Feeling

Sufferers of irritable bowel syndrome (IBS) apparently have more protein receptors for the active compounds in chilli peppers, according to a study to be published June 11 in the journal Gut (PDF). The findings might one day lead to new treatments for IBS.

IBS is a painful, often chronic, condition which can cause cramping abdominal pains, bloating, and bowel problems such as constipation or diarrhea. The new work, carried out at Imperial College London, UK, shows that people with IBS have higher than usual levels of nerve fibres expressing the pain receptor TRPV1, responsible for the experience of the burning sensation when one eats chilli peppers. Finding compounds that block this receptor might lead to novel pharmaceuticals for IBS.

Nutraceutical News

Functional peppers I discovered a rather intriguing perspective on the world of wellbeing, health and nutrition in the latest issue of the journal World Review of Science, Technology and Sustainable Development (2008, 5, 104-123). In it, Sundus Tewfik of the Department of Health and Human Sciences at London Metropolitan University and Ihab Tewfik of the University of Westminster, shed light on nutraceuticals, or functional foods as they are sometimes called. You will doubtless have seen mention of functional foods and botanical dietary supplements as they seem to fill the advertising space in Sunday supplements and feature regularly in lifestyle magazines.

Apparently, nutraceuticals promote wellbeing and underpin public health by providing a supposedly natural way to lower raised cholesterol levels, help unblock clogged arteries, ward off otherwise inevitable cancers, and ease the machinations of the over-sensitive gut. All this, without anyone having to resort to pharmaceutical products and double-blind placebo-controlled clinical trials.

It’s the opening paragraphs of the paper that were the most interesting with regard to the state of play when it comes to the gradual public acceptance of the marketing hype surrounding nutraceuticals:

Consider this domestic scene: it is a typical Sunday morning in an English household in the city of Westminster, London. Mrs Jones is preparing breakfast for her family. Like most mothers, she is concerned about her family’s nutritional status and tries to cook healthy meals. This morning it is an English breakfast, but not just an ordinary one.

Personally, I doubt there are many such domestic goddesses around these days, particularly in Westminster, but more to the point, I think many families these days rush breakfast with at best a quick splash of synthetic fruit juice, and some artificially flavoured cereal rather than feasting on the great English breakfast. But, that aside, the researchers then describe the menu:

The wholemeal bread was made out of grains to increase dietary fibre intake and essential micronutrients, thus helping bowl [sic] movement and support the gastrointestinal tract. The omega 3-enriched eggs will enhance the immune system, reduce the risk of cardiovascular diseases (CVD) and blood clotting. The sugar-free orange juice has added vitamins and antioxidant nutrients, believed to reduce the risk of diabetes, CVD and cancer. The extra virgin olive oil she uses to fry the eggs [You shouldn’t use extra virgin to fry, it degrades rapidly at high temperatures, db] has been chosen to help lowering her mother-in-law high cholesterol.

Agreed, wholemeal bread is probably better for bowel movements than bland and bleached white bread, but wholemeal, while functional, is not the breakthrough health product. After all, my grandmother extolled the virtues of roughage to me decades ago.

The mention of omega acids and antioxidants is possibly valid, but there are no wide-scale trials yet to backup some of the wilder claims made in the popular press. Indeed, adding to one’s diet excessive amounts of antioxidants could ultimately compromise one’s immune system. The i immune system, after all, relies on its own oxidants to kill invading pathogens and destroy cancer cells.

Next, the team suggests that the breakfast sausages with “less than 1% fat” will somehow eliminate any risk of CVD posed by saturated fatty acids. Well, 1% might be described as low fat, but I’d prefer the term reduced, but again, I am not sure how functional are reduced-fat sausages.

One of my many pet peeves regards the claims surrounding so-called organic foods. The jury is still well and truly out on whether there are any benefits and as for the lack of pesticides and fertilisers requires some of those used by organic practitioners are already known to be more hazardous. The beans, tomatoes and mushrooms being “organically grown” also does not take into account the fact that just because Mrs Jones in Westminster can afford the luxury of organic this does not mean organic is better for the world. Energy expenditure for organic farming on a large enough scale to feed the world could be significantly greater than in non-organic methods.

Finally, the salt used by hubby was specially manufactured to help minimise his high blood pressure. Well, yes, I’d concede that’s a functional food. But, whether or not a sprinkle of non-sodium salt is going to benefit Mr Jones’ blood pressure is not beyond doubt; alcohol consumed, cigarettes smoked, processed foods eaten, and genes inherited, play a much bigger role. More to the point, given that the sausages will have been made with salt, why not simply not use salt at all, those organic foods are claimed as more flavoursome anyway, so no need to enhance with salt.

The researchers end their introduction with the thought that this Westminster breakfast is not a scene from ‘Balanced-Nutrition’ program on national television, it is the era of medicinal and functional foods and it is happening as we read this paper in many parts of the world. This is not just food this is ‘functional foods’.

Well, I am not so sure, most of what they describe is not functional in the conventional sense, although elsewhere in the paper they list dozens of functional foods and herbal supplements such as ginseng and Gingko biloba. There may certainl dozens, if not hundreds, of food products now on the market that claim some kind of health functionality. But, the whole notion of a supplemented diet that might improve wellbeing has been stacked very high in recent years. There are shelves full of milky probiotic drinks full of microbes that supposedly repopulate your intestine with good bacteria, products with plant steroids to reduce cholesterol, ward off the menopause, and dozens of herbal extracts each one of which is seemingly a cure-all for a wide range of disparate health conditions.

As long ago as 2001, uber-skeptic of the alternative medicine movement, Edzard Ernst of Exeter University, asked whether functional foods, neutraceuticals, and designer foods are simply an innocent fad or a counterproductive marketing ploy? (Eur J Clin Pharmacol 2001, 57, 353-355). He pointed out that so-called functional foods invariably contain less than therapeutic quantities of their active ingredients and may contain higher levels of apparently “unhealthy” ingredients such as saturated fats.

Almost a decade later, there is still a lot of health hype in those lifestyle magazines and supermarket shelves are increasingly stacked with organic produce, with its premium price tag, and healthstores are packed with botanical products from all corners of the globe. Is this food fad just a cynical marketing exercise, not only for food manufacturers, who can charge more by making dubious health claims for their products, but also for the pharmaceutical and health-care product companies who are now, as blockbuster pipelines dry up, providing the ingredients for the functional diets we are all being told we must consider.

I suspect, once the advertising revenues dwindle and the lifestyle magazines become necessarily bored with the functional food fad, that ultimately many will be left on the shelf while the next moneyspinner rings the changes at the checkout.

UPDATE> I’ve been having an interesting correspondence with commentator David Lustig who points out that there are some very rigorous double-blind placebo-controlled trials omega 3 products. These were carried out for the approved prescription drug Omacor, sold by Reliant, which is essentially nothing more than purified, concentrated fish oil. It has a profound effect on lowering triglycerides and is currently one, if not the only effective approved drugs for hypertriglyceridemia. Lustig suspects it will probably sell at least US$500M this year.

It’s an interesting point at the extremes there is a blurred division between the pharma and the nutra. However, this FDA approved product can in no way be categorised as being of the same ilk as probiotic yoghurt, although it is nothing more than concentrated fish oil a lot can happen when something is concentrated. More to the point, it will be almost 100% free of the kinds of contaminants, such as mercury, that might be found in the healthfood store kind of omega 3 fish oil products that are at much, much lower concentration.

Catching the Travel Bug

Girl Sunbathing Long gone are the days of a summer break where the biggest health risks were stepping in donkey droppings on the beach or being sick on a fairground ride. These days, trips abroad provide the traveller with a whole range of diseases, so what’s our defence?

Our first line of defence against many of these diseases is our immune system. Unfortunately the immune system is not perfect and cannot always mount an effective attack against invading viruses, bacteria, and parasites. This is where vaccination often comes into play.

Vaccines were essentially discovered by Edward Jenner in the late 18th century. They are based on the idea that the immune system can be stimulated by components of a pathogen — i.e. the virus or bacterium. Proteins or protein fragments (antigens) produced by pathogens alert white blood cells to their presence, which then engulf the pathogen and destroy it. The cells also start to produce Y-shaped protein molecules (antibodies). The tips of the Y match the antigens produced by invaders like a lock to a key.

The antibodies travel through the blood stream and every time they bump into an antigen that they recognise, they lock on to it. This labels other pathogen particles for attack by yet more white blood cells which see the antibody signal and digest the invaders or infected body cells. The immune system retains the chemical blueprints for making the same antibodies again for the next encounter. This is why if you survive childhood diseases such as chicken pox you are unlikely to catch it again in adulthood, although this example belies the fact that chicken pox apparently lies dormant and can re-emerge later in life as shingles.

Vaccination tricks the immune system into thinking a pathogen is attacking by using dead or a deactivated version of the virus or bacterium. The white blood cells respond, creating antibodies against the antigens but without you having to catch the disease first. The blueprints for the antibodies are stored chemically ready for a real invasion of the disease. You need a different vaccine for each disease you might encounter and if you are travelling in the Tropics or the developing world there are quite a few diseases you need protection against.

Diphtheria

Among the diseases for which a vaccine is available is diphtheria. This highly infectious disease is caused by the bacterium Corynebacterium diphtheriae, which affects the upper respiratory tract. Symptoms include a severe sore throat and fever which is followed by the formation of a lethal sticky coating in the nose and throat. The bacteria also release a toxic molecule into the blood — a chain of 535 amino acids, which penetrates cells and kills them.

In the 19th century, scientists discovered a serum that neutralises the diphtheria toxin. This ‘antitoxin’ is made by extracting antibodies and other molecules from the blood of horses that have been vaccinated against diphtheria. To work, the potion has to be administered as soon as symptoms appear because it cannot undo the damage caused by toxin that has already entered body tissues.

During the past 10 years, researchers have been trying to find drugs that can kill the diphtheria bacterium. Researchers at Brandeis University in the USA discovered the switch that starts production of diphtheria toxin, a protein called DtxR. They have determined the exact atom-by-atom structure of this protein and drug designers are now looking for compounds that can deactivate the switch before the toxin is released and so save the lives of diphtheria victims that would otherwise die.

Hepatitis B

Another serious illness you may encounter when travelling the globe is hepatitis B. It is caused by the hepadnavirus but the source in half of all cases is not known. However, sexual transmission, needle sharing among drug users, tattoos and transmission from mother to unborn child cause the other half of cases. The virus incorporates itself into the DNA of liver cells, leading to chronic liver damage and potentially liver cancer. Fortunately, vaccination before exposure provides lifelong protection.

Researchers have also discovered antiviral drugs to treat hepatitis B. These drugs resemble the nucleotide molecules that act as the natural building blocks of viral DNA (the virus’ genetic code). The fake building blocks have unreactive fluoro groups instead of hydrogen atoms at strategic positions. So, once the virus starts to use these fake molecules the duplication mechanism is jammed because unreactive fluoro groups cannot be removed to attach the next nucleotide in the chain. Viral replication is significantly slowed down, giving the immune system a chance to overwhelm the disease.

Unfortunately, the viral DNA is prone to damage, or mutations, which lead to changes in its genetics. Most mutations stop the virus working but occasionally one will benefit the virus. If, for instance, the mutation changes the virus so that it ignores the fake building block, then the antiviral drug will fail and the virus continues to replicate, passing on the mutant genes (DNA fragments) to its offspring.

Some strains of hepatitis have already evolved resistance to antiviral drugs, so scientists are desperately trying to discover replacements that might work together to defeat viral resistance.

Rabies

If you are bitten by a dog or other mammal — notably a bat — when travelling, the wound itself is the least of your worries. Rabies is yet another viral disease best avoided. Its name derives from the Latin word for madness or rage, and it leads to a fear of water (hyrophobia), foaming at the mouth, a swelling of the victim’s brain, and ultimately death. Louis Pasteur and Emile Roux developed a vaccine in 1885, but it only works if administered before symptoms appear.

In 2006, scientists in Brazil investigated the potential of a group of natural plant compounds, phenolic compounds, as antiviral drugs to treat rabies. They discovered that just three of a whole range of compounds tested had some antiviral activity. The structures of these three compounds — 3,4,5-trimethoxybenzoic acid, 3,4,5-trimethoxyacetophenone, and 3,4,5- trimethoxybenzoic acid ethyl ester — could provide a starting point for designing more effective compounds. There is no way of predicting how long that might take and any potential drug would have to go through safety tests and clinical trials before it could be used in medicine, which might take up to 10 years. In the meantime, vaccination remains the only defence, that and avoiding rabid animals.

Typhoid

The disease that killed Alexander the Great, typhoid fever is alive and well across the globe. The Salmonella typhi bacterium multiplies in the blood and spreads by ingestion of food or water contaminated with infected faeces. The bacterium causes a high fever, headache, aching muscles, and death in severe cases.

Previously, antibiotics, such as ampicillin and chloramphenicol, were the standard treatment and saved many lives. However, like so many other diseases, typhoid has evolved resistance, particularly in India and South East Asia. Vaccination, if you’re travelling in affected areas, is therefore essential.

Tuberculosis

Tuberculosis, or TB, a disease once consigned to the history books is now carried by a third of the world’s population. TB is a bacterial infection and as with viruses the bacterial DNA, its genetic code is susceptible to mutations that can help it evolve resistance to antibiotics. This has already happened in many parts of the developing world and among certain sections of society such as the homeless, drug users, and HIV sufferers.

However, the issue of resistance is more complicated than it at first appears. A study published in March 2007 in the Journal of Infectious Diseases suggests that most cases of drug-resistant TB may be due to new infections rather than acquired resistance to the antibiotics. If this research is confirmed it might help scientists devise a new strategy for stopping the spread of this disease.

Malaria

Malaria kills up to three million people each year. Malaria is caused by the Plasmodium parasite carried by infected mosquitoes. The parasites are carried into a person’s bloodstream by a bite from an infected mosquito, they then multiply in the liver and the blood causing a lethal fever.

There is no vaccine against malaria, but there are drugs that protect you from infection. Plasmodium, like many viruses and bacteria, has also evolved resistance to some of these drugs. However, a novel drug derived from Chinese medicine, known as qinghaosu, works well in treating the disease and so far has staved of resistance.

There is a great deal of research underway to find novel drugs to defeat malaria. Scientists at the Toronto General Research Institute and Ontario Cancer Institute recently, for instance, discovered a synthetic compound that targets and kills malaria parasites, including one drug- resistant strain. In January 2007, researchers at Northwestern University in the US worked out how the parasite tricks red blood cells into engulfing it and so perpetuating its lifecycle. New drugs aimed at blocking this process might beat malaria.

Today, most of the diseases we have discussed are confined to the developing world where they pose an enormous public health problem and one that usually affects privileged Westerners only when they travel to such places. However, if climate change occurs some of these could spread to the developed world. Unless we can halt global warming, the time may come when you could catch some of these diseases just by staying at home. Stepping in donkey droppings will then be the least of your worries.

Where in the world?

A selection of souvenirs you might pick up on your travels

Diphtheria – bacterium: former USSR, South America, Northern Africa
Hepatitis B – virus: Africa, parts of Asia, China
Rabies– virus: global, except Australia, New Zealand, UK, Norway, Sweden, Japan,
Singapore, Guam, Taiwan, Fiji, Hawaii
Malaria– mosquito-borne parasite: Africa, Asia, South America
Tuberculosis– bacterium: global, common in Southern Africa, Asia, South America, former USSR
Typhoid – bacterium: Africa, Asia, South America

You can obtain specific advice on diseases via the WHO and CDC sites. Your doctor or national health organisation may also produce online information. For those in the UK that can be found here.