Do You Grind Your Teeth at Night?

Bruxism is the term used to describe excessive teeth-grinding.  It’s probably stress-related, and it can be severe enough to cause a whole range of symptoms and health problems – see the link. At night, the grinding can be noisy enough to bother sleeping partners.  Now two reports given at the American Academy of Neurology meeting provide hope for relief from an unexpected direction – Botox injections.  (I’ve been collecting new indications for Botox since it was discovered, and this one is the latest addition to the list). 

The first study, from the University of Texas, was a double-blind, placebo-injection controlled trial of onabotulinum-A in subjects with nocturnal bruxism.  Patients underwent a test night in the sleep lab, where 6 were excluded from the study as they failed to show bruxism on the polysonograph.  Twenty-three were randomized to either Botox or placebo injections.

Scores on scales for bruxism symptoms and pain at week 4 both showed significant improvement with Botox relative to placebo: averages 47.3 & 44.2 for placebo, 64.5 & 65.0 for Botox, respectively. Non-significant trends in favor of Botox were found for headache, sleep quality and anxiety.  Two of 13 Botox subjects complained of a change in their smiles.  Bruxism symptoms in the Botox group were improved for an average of 103 days with Botox vs. 38 days with placebo. 

The second study, which reported on just 4 patients, came from the Henry Ford Health System in Detroit.  The subjects had developed bruxism after an oxygen-depriving brain injury.  All 4 received Botox intramuscularly (into the jaw muscles); two of them received multiple injections separated by 2 weeks to 3 months.  All 4 of them “responded positively” to the injections, with no side effects reported.

So, this leads the way for more well-controlled clinical studies in this interesting (and annoying) condition, so that FDA can be convinced to add the indication to the growing list of Botox uses.

Don’t Skip Breakfast . . .

. . . if you want to lower your risk of developing type 2 diabetes.   That’s the message delivered by a study reported in the American Journal of Clinical Nutrition.  Scientists at the Harvard School of Public Health examined the possible associations between skipping breakfast, snacking, and the risk of type 2 diabetes in men.

They followed 29,000 men for 16 years as part of the Health Professionals Follow-Up Study; they were free of diabetes, cardiovascular disease, and cancer at baseline, when their eating patterns were assessed.

There were 1,944 cases of type 2 diabetes documented during the follow-up period.  After adjusting for known risk factors for diabetes, including body mass index (BMI), analysis showed that the men who skipped breakfast were 21% more likely to develop diabetes than those who didn’t. Another analysis showed that men who ate only once or twice a day were 25% more likely to develop diabetes than those who had 3 meals a day.  These findings were unaffected by differences in BMI or in the diet quality.  Snacking between regular 3-meals-a-day meals was not helpful, however; this behavior was linked to increased BMI levels, and also to an increased risk of diabetes.

The exact mechanism by which breakfast exerts its ‘protective’ effect must await further studies.  However, it’s pretty clear that you shouldn’t skip breakfast in any attempt to limit calories – cut out the snacks instead.

Supplements Carry Their Own Risks!

Nutritional health supplements are used by about half the US population, although proof of their clinical effectiveness is usually lacking.  Some supplements are marketed as protection against cancer, but there’s no evidence that they work from controlled clinical trials.  Now there’s a report that high doses of some supplements can actually increase the risk of cancer.  It’s published in the Journal of the National Cancer Institute.

University of California San Diego Cancer Center UCSD-CC) researchers reviewed available medical literature for supplements that were tested in adequate clinical studies or in large well-designed observational studies.  They found some lab studies that supported the use of antioxidants (e.g. beta-carotene, alpha-tocopherol, and vitamn C), folic acid, vitamin D, and calcium to prevent cancer in animals or cell-culture models. But 7 well-designed and well-conducted clinical studies failed to support the favorable laboratory evidence in the case of beta-carotene, alpha-tocopherol, selenium, and vitamins A, C, and E, alone or in combination.  One exception – a trial in China showed a 13% reduction in cancer mortality and a 21% reduction in gastric cancer mortality in people randomized to a combination of beta-carotene, vitamin E, and selenium.

Several antioxidant trials have shown increased cancer risk with supplementation, the UCSD-CC investigators wrote.  Most notably, two randomized trials of patients at high risk for lung cancer because of smoking or exposure to asbestos showed an increased incidence of lung cancer in the subjects taking beta-carotene.  And two randomized clinical studies showed an increased risk of prostate cancer and precancerous colon lesions (adenomas) in subjects taking long-term folic acid long-term.  With regard to vitamin D, the authors stated: “there was not enough evidence to state that there is a causal association between low vitamin D intake and increased cancer risk."  More studies are clearly needed to determine whether vitamin D has any preventive effects on cancer. 

Conclusions?  The researchers write:  "Given the current state of the evidence, do we need to conduct more randomized controlled trials of dietary supplements to assess their efficacy for cancer prevention?  We do, but these trials must be designed strategically and in light of lessons learned from previous studies.  In the absence of convincing evidence that more will be better, we probably do not need more trials in nutrient-replete populations”.  In other words, there may not be any evidence of the benefits of supplements in preventing cancer.  I say, save your money!

Obese Diabetics Do Better with Surgery, Rather Than Intensive Meds

Bariatric, or weight-loss, surgery has become increasingly popular in treating severe obesity.  More recently, it’s found a place in the management of type 2 diabetes in obese subjects.  A report in the New England Journal of Medicine describes a comparison of outcomes in obese diabetics treated by intensive medical care or intensive medical care plus bariatric surgery; it came from Cleveland Clinic and Boston researchers involved with the Bariatric and Metabolic Institute, Cleland Clinic, Ohio.

A total of 150 obese patients with uncontrolled type 2 diabetes (average age 48, 66% women) were randomly assigned to intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy.  The subjects’ average glycated hemoglobin level (HbA1c) was 9.2% at entry; the primary goal of the study was the proportion of patients with an HbA1c level of 6.0% or less 12 months after treatment.

In all, 93% completed 12 months of follow-up.  Glycemic control improved in all three groups, with an average HbA1c of 7.5% in the medical-therapy group, 6.4% in the gastric-bypass group, and 6.6% in the sleeve-gastrectomy group.  In the medical-therapy group 12% of the patients met the goal of 6% HbA1c (5 of 41 patients), compared with 42% of patients (21 of 50) gastric-bypass group and 37% (18 of 49) in the sleeve-gastrectomy group.  And weight loss was greater in the gastric-bypass and sleeve-gastrectomy groups: -29 kg (-64 lbs) and −25 kg (-55 lbs), respectively, vs. -5.4 kg (-12 lbs) in the medical-therapy group.  Medication use decreased significantly after both surgical procedures but increased in patients given medical therapy only. Four patients underwent reoperation.  There were no serious complications of surgery.

This study (and another from Rome, Italy, reported in the same issue of the Journal) showed that bariatric surgery in obese diabetics is clearly superior to management by medication alone.  Of course, both methods require accompanying improvements to lifestyle (diet and exercise!).

Weight Training Helps Women with Mild Cognitive Impairment

“Pumping iron” is not always included in physical activity programs for women, but it probably should be, according to results from a Canadian research study.  Investigators at the University of British Columbia in Vancouver compared the benefits of resistance exercise with that of aerobic exercise and no exercise in older women with mild cognitive impairment.  They published their findings in a letter to the Archives of Internal Medicine. 

A total of 86 women ages 70-80 with memory complaints and a score lower than 26 out of 30 on the Montreal Cognitive Assessment test were enrolled.  They were randomly allocated to twice-weekly sessions of resistance (machines and weights), aerobic (outdoor brisk walking), or balance and tone training (stretching, balance and relaxation exercises).  The trial lasted 6 months.  The primary outcome was performance on the Stroop Test, which measures selective attention and conflict resolution, but other aspects of executive cognitive function, including everyday problem-solving ability, were also tested.  Functional MRI (magnetic resonance imaging) was done on 22 of the participants (7 or 8 from each group) to assess regional patterns of functional brain activity during the memory tests. The investigators also assessed general balance, mobility, and cardiovascular capacity.

After 6 months the resistance training group had significantly improved performances on the Stroop Test and the associative memory test, compared to the ‘control’ group (stretching, balance and relaxation). .  They also had significant functional changes in three cortical brain regions on functional MRI.  The aerobic training group showed significantly improved general balance, mobility, and cardiovascular capacity, but no change in memory function. 

This study shows that resistance training has several benefits in terms of cognition, at least for older women. The results here may not apply to men or younger women, but they probably do, and resistance exercises are an important component of a healthy lifestyle, at any age.

Eat More Low-Fat Dairy Foods and Reduce Your Stroke Risk

When we talk of dairy food we often think of milk, cheese, and ice-cream.  But there’s more to it than that – there’s low-fat and high-fat dairy food, and they can have different effects in the body. An example of this is the report published in the journal Stroke, which suggests that a high intake of low-fat dairy foods might offer protection against stroke.

The study was conducted in Sweden, a dairy-loving country.  Karolynska Institute researchers enrolled almost 75,000 men and women who were free of cardiovascular disease and cancer, and who completed a 96-item food-frequency questionnaire in 1997.  They were then followed for an average of 10.2 years.

During the follow-up period, just over 4,000 participants had a stroke – 3159 ischemic, 583 hemorrhagic, and 347 ‘unspecified’ strokes.  Total dairy, full-fat dairy and milk, yogurt, and cheese consumption didn’t correlate with the total risk of stroke or ischemic stroke.  However, with low-fat dairy it was another story.

Analyses were made after adjustments for differences in age, gender, smoking, education, body mass index, physical activity, aspirin use, high blood pressure, diabetes, and various nutritional components.  Compared with women and men in the lowest 20% of low-fat dairy food consumption (zero servings a day), those in the highest 20% (4 servings per day) had a 12% lower risk for any type of stroke and a 13% lower risk for cerebral infarction. 

Previous clinical and laboratory studies have shown that proteins in milk products can lower blood pressure, and this means that low-fat dairy's protective effect might be mediated by blood pressure reductions.  In connection, we should remember that low-fat dairy is one component of the anti-hypertensive DASH diet (Dietary Approaches to Stop Hypertension).

Low-fat dairy foods and beverages include low-fat milk, low-fat yogurt, cottage cheese, and low-fat cheese.  An editorialist has commented that it’s unknown which components of low-fat dairy are protective - it may be the calcium, vitamin D, potassium, or the magnesium, all of which are known to lower blood pressure.  So it's important to consume low-fat dairy foods, because vitamin and mineral supplements may not provide the same protection.

Dogs Taken to Work Reduce Their Owner’s Stress Levels

There are quite a few reasons why the movement to allow pets in the workplace is growing.  However, not much scientific proof of benefits has been provided to date. Now researchers from Virginia Commonwealth University, Richmond, have reported their findings from an investigation into stress in workers at a company that allows employees to bring their dogs to work.  It’s published in the International Journal of Workplace Health Management.     

The main purpose of the study was to assess employee base physiological stress levels and perceived stress during the workday in subjects from 3 groups – dog owners who brought their dogs to work (DOG group), dog-owners who chose to leave their dogs at home (NODOG group), and non-pet owners (NOPET group).  The setting was a service-manufacturing-retail company where 20 to 30 dogs are on the company premises each day.  For the study there were 18, 38, and 19 dogs in the three groups, respectively.  Physiological stress in the employees was measured using salivary cortisol levels, while perceived stress was assessed with a visual-analog scale; the scale ranged from “none” to “the most stress imaginable”.  Questionnaires were used to determine levels of job satisfaction and perceived organizational support.

No significant differences were found between the groups on physiological stress or perceived organizational support.  Perceived stress was the same in the 3 groups at baseline (i.e.in the morning), but over the course of the day it declined for the DOG group with their dogs present and increased for the NODOG and NOPET groups; the NODOG group had significantly higher stress levels than the DOG group by the end of the day.  In a separate test, DOG group members were asked to leave their dogs at home for the day; on a dog-absent day owners’ perceived stress level increased during the day, mirroring the findings with NODOG group members.

This study provides evidence of beneficial effects of being able to take your dog to work.  As I’m retired and blog from my home, my dog Teddy (photo below) can come and watch me ‘work’ whenever he wants.  I can assure you that my perceived stress level is low, and remains low throughout the day.  And Teddy seems to enjoy life, too.

Periodontal Disease Is Important, But Not the Cause of Heart Attack

I’ve repeatedly pointed out that an association between two factors or conditions doesn’t prove a cause-and-effect relationship.  This is emphasized in a statement from the American Heart Association, published online in Circulation, which throws doubt on periodontal gum disease being a true cardiovascular risk factor.

As early as 1989 a link between the occurrence of gum disease and heart attack was reported, and since then there have been many publications describing such an association.  It’s recognized that the two conditions share several common risk factors: increasing age, smoking, alcohol abuse, lesser education and socioeconomic status, diabetes, and overweight or obesity.  In view of increasing claims that treating periodontal disease can protect against atherosclerotic heart disease, the American Heart Association charged an expert writing group to determine if there are available data to support an independent association between the two conditions, and whether periodontal disease treatment might modify atherosclerosis risks or outcomes.

A total of 547 peer-reviewed medical articles were evaluated by the writing group.  Study design and quality affected the weight attached to the results.  Some studies reported an association between periodontal disease and cardiovascular atherosclerosis, others did not.  The expert group concluded that, although there was evidence from observational studies to support such an association, there was none supporting a causative relationship.  Moreover, there was no evidence that treating periodontal disease prevented cardiovascular atherosclerosis or modified its outcomes.

The lead author of the publication concludes “. . .while good oral hygiene is obviously still important, patients should not be distracted by periodontal disease in trying to lower their rates of heart attack and stroke.  Rather, they should focus on the well-known causes of heart disease such as hypertension, obesity, and high cholesterol.  Reducing these things can make a real difference.”  Based on this report, that’s good advice.