ShortCuts-This Week in the Journals

August 4, 2008

Nanjing Wall

Commentary by Neil Shapiro, Editor in Chief, Clinical Correlations 

Summer. A time for exercise, eating right and staying healthy. It’s a time to take things slow and focus on the lighter side of life. Summer is definitely a time to avoid delving into the deep, heavy, ground breaking stuff. So consider this a disclaimer for this week’s edition of ShortCuts- it’s a few less calories, not quite earth shattering but no less intriguing…ironically keeping with our theme this week , researchers everywhere focused their less than earth shattering papers on weight, sugar, cholesterol and magical exercise…

This week MedPage Today pointed to an article in a journal you and I probably don’t have on our radar, The Journal of Nutrition. The authors took 6 healthy subjects and gave them carbohydrate boluses of either glucose or varying degrees of a glucose to fructose mix.  They found that when fructose was consumed, absolute lipogenesis was 2x greater than when fructose was absent. Triglycerides and triglyceride rich lipoproteins were also increased showing that intake of fructose rapidly stimulates lipogenesis and can elevate triglyceride synthesis. Why is this important? Just spend a moment perusing your cupboard…ketchup, sodas, cookies and cakes all list as their first or second ingredient high fructose corn syrup. Thus it follows from studies like this that not only is fructose at least partially responsible for our obesity epidemic, but it may have a bit to do with coronary artery disease as well.

While we’re on the subject of lipids, the New England Journal of Medicine published an article online early last week that attempts to elucidate the etiology of statin induced myopathy. Researchers did a “genomewide association study” comparing patients with and without myopathy after using a statin and looked for possible genomic markers. There was a single strong association with the rs4363657 single-nucleotide polymorphism (SNP) located within SLCO1B1 on chromosome 12. Prevalence for this allele is approximately 15% in the population and conferred an odds ratio for myopathy of 4.5%. This is yet another example of a future where we will look at our patient’s genome prior to giving out prescriptions and determine the best and safest cocktail of medications. The future, it appears, is getting closer every day.

Keeping with our weighty theme, this week’s British Medical Journal shows that at least in England the perception of what is obese has changed. Researchers surveyed close to 1000 men and women in 1999 and then another group in 2007. Not surprisingly, self reported weight increased over time, but more disturbingly, 81% of participants correctly identified themselves as overweight in 1999 but only 75% did so in 2007. Despite all the efforts in the media and government in England, the population there increasingly does not see their weight as a problem. I really can’t believe this study could be replicated in the United States, we’re so much more attuned to our bodies and eat so much healthier than our British counterparts…now pass me a donut.

Leave it to our nation, however, to focus our research dollars on a pill that can make you more physically fit. The media picked up an article in Cell which showed the effects of such a pill. Researchers developed a drug that stimulates amp activated protein kinase AMPK, a key protein that regulates exercise physiology. Running has been shown to activate AMPK so they tested whether this drug Aicar, which is an orally active AMPK agonist, with or without exercise training could improve endurance. Sedentary mice (the ones they found sitting on the couch watching TV?) were treated for 4 weeks with the drug or placebo and they found a 44% increase in endurance on a treadmill in those treated with the drug.  A quick Google search of this new drug shows that clearly from the discussion forums everywhere, this is the possibility everyone is looking for-who needs to go to Crunch, maybe I’ll just pop this pill and hop in my SUV for a drive back to Dunkin Donuts.

And finally, departing a bit from all this talk about donuts…from the category of who knew: This week’s Thorax, a British pulmonary journal, has a letter to the editor (I do scour the journals, but I have to admit the New York Times found this one for me) that thunderstorms can trigger an asthma exacerbation. Researchers reviewed the emergency room records of 41 hospitals during an 11 year period and found a 3% increased incidence of asthma visits on days following thunderstorms. The authors explain the hypothesis generated from prior studies: “pollen grains rupture by osmotic shock in rainwater, releasing allergens, and that gusty winds from thunderstorm downdrafts spread particles and/or aeroallergens, which may ultimately increase the risk of asthma attacks.” So maybe the best advice we can offer our asthmatic patients is move to the desert…and step away from the donuts.

Picture: Nanjing Wall, Nanjing, China, courtesy Wikimedia Commons