Monday, April 9, 2012

Understanding Viral vs. Bacterial Infections - Part 1, The Microbes

Microbes are microscopic living organisms, such as bacteria and fungi. Although often categorized as microbes, viruses are very different. In fact, since viruses are unable to grow or reproduce unless they enter a living cell, viruses are sometimes not considered to be living creatures at all. In order to compare and contrast viral and bacterial infections, it is first necessary to gain an understanding of the microbes themselves.

Bacteria - Bacteria first appeared on the Earth billions of years ago. Through a process known as photosynthesis, they are thought to have helped produce the oxygen environment that is essential to animal life. A distinguishing feature of bacteria is that they have only one cell. Although one type of bacteria can be seen with the naked eye, most are so small that thousands could fit in the eye of a needle. There are many of types of bacteria, but most of them are of one of three different shapes- rods (bacilli), spheres (cocci), or spirals (spirilla). Within the human body, there are approximately ten times as many bacteria as there are human cells, a majority of these located on the skin and in the bowel.

A typical bacterium (the singular of bacteria) has a rigid cell wall that contains a fluid called cytoplasm within the cell. Floating in the cytoplasm is the nucleoid or genetic material of the bacterium (DNA and RNA) that allows the bacterium to reproduce itself. Some bacteria even have threadlike structures called flagella that provide propulsion.

Some people think of bacteria only in terms of being "germs", or harmful microorganisms that invade our bodies and cause disease. And in fact, many serious infectious diseases including tuberculosis, strep throat, tetanus, Lyme disease, and gonorrhoea are caused by bacteria. The disease causing varieties, however, constitute only one percent of all bacteria. Most bacteria are harmless, and a few are even beneficial to humans. For example, Lactobacillus acidophilus is a bacterium that lives in the intestines and helps us to digest food and protects against "bad" bacteria that can cause disease. Another type of bacteria in the gut provides us with Vitamin K.

In addition to their role in human health and disease, bacteria have a number of other functions. Bacteria are involved in the break down of garbage and production of compost from vegetation. Bacteria are also used in making healthy foods like yogurt and cheese. Bacteria that digest and dissolve hydrocarbons have even been used to clean up oil spills.

Viruses - As compared to bacteria, viruses are much less complex. For one thing, an average bacterium is hundreds of times larger than most viruses. Instead of being even one-celled like bacteria, viruses are considered to be non-cellular, meaning that they consist of a packet of genetic material (DNA or RNA) carried in a shell called the capsid.

The most distinguishing feature of viruses is that without the benefit of a living host, viruses are essentially dormant, meaning that they are unable to multiply or to cause any harm. When viruses encounter appropriate host cells, however, they are able to release their genetic material into the cell. Once inside, the viral genetic material takes over the host cell’s normal functioning with its own set of instructions. This shuts down the usual cell functions and directs it to produce new virus particles. In this way, the virus becomes a "parasite" on the cell with the host cell doing the work under the instructions of the virus.

Another important distinction is that unlike bacteria, most viruses do cause disease. They exist for one purpose only which is to reproduce, and in the process, they take over and ultimately destroy host cells. Viruses have evolved to infect every form of life, from animal to plant-life. In fact, the first virus to be discovered, the tobacco mosaic virus, affects the tobacco plant, rather than humans.

Viral illnesses can range from relatively mild to fatal. The common cold, influenza, cold sores, and chicken pox are viral illnesses that typically "run their course". Hepatitis B and AIDS are chronic viral illnesses that can ultimately be fatal. Rabies and Ebola are viral infections that can rapidly cause death. One of the worse aspects of viral infections is that certain viruses are capable of triggering the development of cancer. For example, along with being a well-known cause of cervical cancer, the human papilloma virus (HPV) has become the leading cause of throat cancer in this country.

With this background on the nature of viruses and bacteria, next week we'll look at the differences in the infections that are caused by these microbes.

Thursday, March 29, 2012

Dietary Salt, TOO much or TOO little?

Today's Health Tip would have to fall under the "more research is needed" category. Nevertheless, recently published studies regarding salt intake and health are helping to define the optimal amount of salt that we should be eating and are worth considering at this time.

What is salt? Common table salt is a mineral made up primarily of sodium chloride (NaCl).The sodium (Na) component of salt is essential to human life, as it is required for important functions such as muscle contraction, including heartbeat, and nerve conduction. Too much sodium in the body, however, has been linked to health risks, such as high blood pressure, stroke, and heart disease. Each gram (1000 mg) of table salt contains approximately 400 mg of sodium. As a reference, one teaspoon of salt is equal to approximately 6 grams of sodium chloride or 2,360 mg of sodium.

What is the "party line" regarding salt intake? The U.S. Centers for Disease Control and Prevention (CDC) has taken the position that 90% of adults in the U.S. consume more sodium than is recommended. The current average intake of sodium per day in the U.S. is around 3400 mg or 8.5 grams of salt. The CDC recommends that the maximum sodium intake among the general population should be 2300 mg, or approximately one teaspoon of table salt a day. For specific high-risk groups, such as African Americans or individuals with high blood pressure, chronic kidney disease, or diabetes, the CDC recommends eating no more than 1500 mg of sodium per day. The American Heart Association (AHA) is even more restrictive, advising everyone to limit his or her sodium intake to 1500 mg per day.

Where does sodium come from in the diet? In a survey of American households from 2007-2008, it was determined that 44% of the sodium consumed came from 10 food categories: bread and rolls, cold cuts/cured meats, pizza, poultry, soups, sandwiches, cheese, pasta mixed dishes, meat mixed dishes, and savory snacks. Around two-thirds of this sodium came from foods obtained from stores, such as supermarkets or convenience stores with 25% coming from restaurants.

What is the harm of eating too much salt? Many studies have demonstrated a direct relationship between sodium intake and high blood pressure, which is a well-known risk factor for the development of coronary heart disease, stroke, and chronic kidney disease. Several countries that have sponsored campaigns to reduce salt intake have reported marked lowering of disease linked to excess sodium. In Japan, a public campaign resulted in a reduction of sodium intake from 13.5 to 12.1 grams per day. Following this modest reduction, an 80% reduction in stroke mortality occurred. In Finland, a gradual reduction in salt intake by one-third occurred over a 30 year period. This was accompanied by a 75 to 80% reduction in deaths from stroke and coronary heart disease, along with a 5 to 6 year increase in life expectancy. A study in the U.S. found that by reducing dietary salt to 3 grams (1200 mg of sodium) per day that we could reduce the number of heart attacks each year by up to 100,000 per year and strokes by up to 66,000 while saving anywhere from 10 to 24 billion dollars in health care costs.

Recent studies that have "rocked the boat". Unfortunately, not all of the recent research agrees in terms of the optimal amount of sodium that we should be eating. Two recent studies published in the Journal of the American Medical Association suggest that there is a minimal level of salt consumption, higher than the amount suggested by the CDC, that is protective in terms of the development of heart disease. These studies (not surprisingly being heartily endorsed by the Salt Institute), seem to indicate that for "normal" people, without problems such as hypertension or heart failure, more liberal salt consumption is not as great a concern as has previously been thought. One kidney specialist has proposed a compromise between the CDC's position and the recent contradictory studies, suggesting that people who are not in a high-risk group should aim for a salt intake of no less than 3 grams (1200 mg of sodium) per day and no more than 7 grams (2800 mg of sodium) per day.

How can sodium consumption be reduced? In those who need to restrict their sodium intake, paying attention to the 10 "salt offenders" mentioned above is a great place to start. Processed foods such as pre-prepared dinners, cold cuts and bacon, cheese, and soups are particularly high in sodium. Two of the leading sources of sodium in restaurant food come from pizza and poultry items. Other suggestions are to limit sodium-laden condiments such as soy sauce, salad dressings, dips, ketchup, and mustard, and to use herbs or spices instead of salt to season food. The Institute of Medicine has called on the government, public health groups, and consumer agencies to help also with the problem of excess sodium in foods that we consume. They would like to see the U.S. Food and Drug Administration develop a national standard for the sodium content of foods and are asking the food industry to voluntarily reduce the sodium content of food.

Setting standards would be much easier to accomplish, of course, if we knew exactly how much is enough and how much is too much. Hopefully, ongoing research will provide these answers. For the time being, however, the recommendations of the CDC, maintaining a salt intake around 6 grams (2300 mg of sodium) per day, seem to be appropriate. For those in whom excess sodium represents a health risk, such as anyone with high blood pressure, chronic kidney disease, or heart failure, sodium intake should be less than 1500 mg per day. Remember that the sodium that we receive in our diet comes not only from the salt added while cooking or at the table, but also from "hidden" salt in processed foods.

Friday, March 23, 2012

Nine things you should know about type 2 diabetes


According to the CDC, 25.8 million children and adults in the United States - representing 8.3% of the population - have diabetes. This represents an increase of roughly 15 percent in just the past few years. Unfortunately, there is a great deal of misunderstanding about this disease, some of which can lead to a delay in diagnosis and worsening of complications. More importantly, people who can be identified as being at risk for developing diabetes may have an opportunity to prevent the disease from occurring.
  1. Type 1 and type 2 diabetes have different causes. Type 1 diabetes is a disease that develops when the body's immune system attacks the pancreas resulting in a deficiency of insulin. Without insulin, the body is unable to convert sugar and other starches into energy and the blood sugar can rise to dangerous levels. A person who has type 1 diabetes must take insulin on a regular basis to live. Only about five percent of all people with diabetes have type 1 diabetes. Type 2 diabetes, affecting about 95% of diabetics, develops over time due to genetics and lifestyle factors. These factors include physical inactivity and poor diet. In type 2 diabetes, the cells don't recognize and properly use the insulin that the body produces, a problem known as insulin resistance.

  2. Certain people are at higher risk of developing type 2 diabetes than others. This includes those people with: 1) a family history of the disease, 2) excess body weight, 3) low physical activity, 4) high blood pressure, 5) abnormal blood lipids (HDL under 35 mg/dL or triglycerides higher than 250 mg/dL), and 6) diabetes during a previous pregnancy. People over the age of 45 and certain ethnic groups, including African Americans, Hispanic Americans, Asian Americans, and Native Americans, are also at increased risk of developing type 2 diabetes.

  3. Many people with type 2 diabetes do not realize that they have it. Symptoms most commonly associated with type 2 diabetes include feeling thirsty, having to urinate more than usual, staying hungry, tiredness, and losing weight without trying. Many people with type 2 diabetes, however, have no symptoms at all. According to the American Diabetes Association, about 16 million people in the United States, or approximately one-third of all people with diabetes, are unaware that they have it.

  4. Before developing type 2 diabetes, most people have a condition known as "prediabetes". In prediabetes, blood glucose levels are higher than normal but not high enough to be diagnosed as having diabetes. Approximately 79 million people in the United States have prediabetes. Although prediabetes is usually not associated with symptoms, long-term damage to the body, especially the heart and circulatory system, may already be occurring.

  5. Complications of diabetes can affect many areas of the body. Sugar or glucose that is not converted into energy by the cells can damage the blood vessels, heart, nerve endings, kidneys and eyes. This results in an increased risk of stroke, high blood pressure, blindness, kidney disease and amputations of the limbs. Fortunately, good control of diabetes can significantly reduce the risk of developing or worsening of complications. Consider these statistics related to diabetes-related complications:

    • Diabetes is the leading cause of blindness in adults.

    • Diabetes is the leading cause of kidney failure.

    • About 60% to 70% of people with diabetes have mild to severe forms of nerve damage.

    • The risk for stroke is 2 to 4 times higher among people with diabetes.

    • Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults who do not have diabetes.

  6. Type 2 diabetes is not just an adult disease. In In the past, children with diabetes almost always had type 1, the variety that occurs when the immune system attacks the pancreas, resulting in insulin deficiency. Over the past decade, however, there has been a marked increase in the number of children and adolescents diagnosed with type 2 diabetes. Most of these cases appear to be related to a combination of obesity and physical inactivity. The actual number of children with type 2 diabetes may even be underestimated since it can remain asymptomatic and undiagnosed for a long time.

  7. Diagnosing type 2 diabetes is easy. On One of the best and easiest ways to check for diabetes is by drawing blood from the arm after not eating for 8 hours and measuring the amount of glucose in the plasma. The American Diabetes Association recommends testing for diabetes every 3 years in everyone over the age of 45. The United States Preventive Services Task Force (USPSTF) recommends that people with blood pressure higher than 136/80 also be tested. Testing for diabetes should begin at a younger age in someone who is overweight and has risk factors, such as a parent with type 2 diabetes, or is a member of certain ethnic groups, including African and Native Americans.

  8. A 3rd type of diabetes affects pregnant women. Known as gestational diabetes, this type of diabetes usually starts in the middle part of the pregnancy. Like type 2 diabetes, it is associated with insulin resistance and elevated blood sugar. The excess sugar in the bloodstream commonly causes the baby to grow too large (macrosomia). Potential complications of gestational diabetes include an increased risk of newborn death and stillbirth, delivery-related complications due the infant's large size, and an increased risk of the child developing diabetes later in life. All pregnant women should receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for the condition.

  9. Type 2 Diabetes is often a preventable disease. The good news is that in many people with risk factors or who have prediabetes, type 2 diabetes can be prevented. In these people, moderate weight loss (10-15 pounds) along with 30 minutes of moderate physical activity (such as brisk walking) each day is often enough to prevent its development.
To learn more about type 2 diabetes, refer to the CDC's Diabetes and Me or see
Diabetes Basics sponsored by the American Diabetes Association.