Can fat 'feel' fat? Size-sensing protein controls glucose uptake and storage in fat cells
by University of Iowa

Researchers at the University of Iowa have discovered that a molecule which can sense the swelling of fat cells also controls a signaling pathway that allows fat cells to take up and store excess glucose. Mice missing this protein, known as SWELL1, gain less weight (fat) than normal mice on a high-fat diet, but also develop diabetes.

"Although we have created a mouse that is resistant to weight gain by removing the SWELL1 protein, the mouse is not healthy; it has insulin resistance and glucose intolerance," says Rajan Sah, MD, PhD, assistant professor of internal medicine at the University of Iowa Carver College of Medicine and senior author of the study.

Type 2 diabetes is one of the more serious health problems associated with obesity. The disease makes cells less sensitive to insulin and causes blood sugar levels to become abnormally high. It is healthier for the body to store excess glucose as fat rather than have it circulating in the blood where it can damage blood vessels and nerves.

In healthy people, insulin released in response to high glucose levels acts on many different tissues to coordinate use or storage of the glucose. It triggers fat cells to take up excess glucose and store it as fat.

Sah's study, which was published recently in Nature Cell Biology, found that removing SWELL1 from fat cells in mice disrupts this insulin signaling pathway and prevents fat cells from taking up glucose.

Sah and his team homed in on SWELL1 because of several pieces of converging evidence. Fat cells have a tremendous capacity to expand - up to 30 times their normal volume in the context of obesity. It's also long been known that changes in fat cell size alters fat cell signaling.

Through exploratory experiments investigating cell swelling in fat cells from lean and obese mice as well as fat cells obtained from bariatric surgery patients, Sah and his team serendipitously identified SWELL1 protein as an essential component of fat cells' volume-sensing mechanism. From unrelated work by other researchers, they also knew that this protein was involved in a signaling pathway common to all cells. In fat cells this pathway regulates glucose uptake in response to insulin.

"We thought maybe this SWELL1 protein is what links the two pieces together - the size-sensing mechanism and the signaling pathway that responds to size changes by altering insulin sensitivity," explains Sah, who also is a member of the Fraternal Order of Eagles Diabetes Research Center, and the Abboud Cardiovascular Research Center at the UI.

The team's study showed that swelling of mouse or human fat cells, either artificially in a petri dish, or because the cells have expanded due to obesity, activates SWELL1 signaling. Removing SWELL1 from mouse fat cells knocks out this volume-sensing signal and disrupts the insulin signaling pathway used by fat cells to take up and store excess glucose. Mice missing SWELL1 have smaller fat cells, but also develop insulin resistance and glucose intolerance.

Interestingly, on a regular diet, mice missing SWELL1 had body weights, fat composition, and metabolism that were all essentially the same as a normal mouse. The only difference was they had no SWELL1 activity in their fat cells, as well as reduced ability to clear glucose from the blood and impaired insulin sensitivity (insulin resistance).

When the mice were put on a high-fat diet, the mice missing SWELL1 did not gain weight as fast as the normal mice but the insulin resistance and glucose intolerance became worse.

"The idea that fat is bad is not necessarily true," Sah says. "Too much fat is bad, and fat in the wrong places is bad, but fat in the right place and allowed to expand normally may be somewhat protective against diabetes.

"If fat cells can sense their own expansion, then SWELL1 protein might be the mechanism for that," he continues. "What we see here is what the cell does with the information that it is getting bigger. It turns on a signaling pathway that modulates glucose uptake and insulin sensitivity. From this discovery, we can start to look at whether we can target this modulation of insulin sensitivity in a therapeutic way."

Your muscles can 'taste' sugar, research finds
by Stephanie King, University of Michigan

An illustration of the Baf60c-Deptor-AKT signaling pathway identified as a target of myocyte glucose sensing that augments muscle insulin action. Credit: Stephanie King/LSI
It's obvious that the taste buds on the tongue can detect sugar. And after a meal, beta cells in the pancreas sense rising blood glucose and release the hormone insulin—which helps the sugar enter cells, where it can be used by the body for energy.

Now researchers at the University of Michigan Life Sciences Institute have uncovered an unexpected mechanism of glucose sensing in skeletal muscles that contributes to the body's overall regulation of blood sugar levels.

"We found that skeletal muscle cells have machinery to directly sense glucose—in a certain sense it's like the muscles can taste sugar, too," said senior study author Jiandie Lin, a faculty member at the LSI, where his lab is located.

This ability of muscles to sense blood glucose is a separate and parallel process that augments the insulin-driven response. Together they work as a rheostat to maintain steady glucose levels in the body, particularly after a meal, according to findings published May 4 in Molecular Cell.

Continuing to develop this in-depth understanding of how the body self-regulates blood sugar at the molecular level could shed new light on obesity and diabetes, as well as point toward new therapeutic targets, said Zhuoxian Meng, the study's lead author and a research investigator in Lin's lab.

The researchers were able to examine the contributions of the glucose-sensing pathway in skeletal muscle by silencing a key gene—BAF60C—in cell cultures and in laboratory mice.

"When we did that, the mice lacking BAF60C looked absolutely normal, but after we gave them a high-fat diet to induce obesity, they developed trouble disposing of the additional glucose after a meal," Lin said. "The well-known insulin mechanism was not sufficient to process the glucose on its own."

Elevated blood sugar following a meal is a key symptom of Type 2 diabetes. And chronic high blood sugar, also known hyperglycemia, can lead to serious health issues.

"We found that the molecular pathway that's engaged by glucose in muscle cells, at least the initial steps, is very similar to what happens in the beta cells in the pancreas," said Lin, who is also a professor of cell and developmental biology at the U-M Medical School. "This is very interesting because there's a very important class of diabetes drugs known as sulfonylureas that act by closing a potassium channel and causing the beta cells to secrete more insulin.

"Our research shows that this glucose-sensing pathway in muscle cells likely also plays a role in the drugs' overall glucose-lowering action. The extent of the pathway's contribution will need to be studied further."

Additionally, Lin said, there are two steps within the glucose-sensing pathway that could serve as potential targets for modulation with therapeutic compounds.

"It's amazing how subtle changes in glucose can be detected throughout the body," Lin said. "Beta cells respond, nerve cells respond, and now we know that muscle cells respond directly, too."

Pathways leading to beta cell division identified, may aid diabetes treatment
by University of California - San Diego

Researchers at UC San Diego School of Medicine identified pathways that regulate pancreatic beta cell (pictured in green) growth. These cells help maintain normal blood glucose levels by producing the hormone insulin. Credit: UC San Diego Health
Pancreatic beta cells help maintain normal blood glucose levels by producing the hormone insulin—the master regulator of energy (glucose). Impairment and the loss of beta cells interrupts insulin production, leading to type 1 and 2 diabetes. Using single-cell RNA sequencing, researchers at University of California San Diego School of Medicine have, for the first time, mapped out pathways that regulate beta cell growth that could be exploited to trick them to regenerate.

The findings are published in the May 2 issue of the journal Cell Metabolism.

"If we can find a drug that makes beta cells grow, it could improve blood sugar levels in people with diabetes," said Maike Sander, MD, professor in the Department of Pediatrics and Cellular and Molecular Medicine at UC San Diego School of Medicine. "These people often have residual beta cells but not enough to maintain normal blood glucose levels."

The body generates beta cells in utero and they continue to regenerate after birth, but as people age, cell regeneration diminishes. The predominant way to grow new beta cells is through cell division, but beta cells capable of dividing are rare, compromising less than 1 percent of all beta cells. Scientists have been investigating molecular pathways that govern beta cell growth in hopes of finding new therapies that would help people regain blood glucose control after the onset of diabetes.

In their study, Sander's team identified the pathways that are active when beta cells divide providing insight into possible drug targets. Using single-cell RNA sequencing, the team was able to profile molecular features and metabolic activity of individual beta cells to determine how dividing beta cells differ from non-dividing cells.

"No one has been able to do this analysis because the 1 percent or less of beta cells that are dividing are masked by the 99 percent of beta cells that are not dividing," said Sander. "This in-depth characterization of individual beta cells in different proliferative states was enabled by newer technology. It provides a better picture of what sends beta cells into cell division and clues we can use to try to develop drugs to stimulate certain pathways."

Whether stimulating beta cells to grow will result in therapeutic interventions for diabetes is still to be seen, but this new information opens the door to find out, said Sander.

New type of insulin-producing cell discovered
by Andy Fell, UC Davis

Insulin is made in pancreatic islets by beta cells. In type I diabetes, these cells are lost. Now UC Davis researchers have identified another type of insulin-producing cell in the islets, which appears to be an immature beta cell (shown in red in this image). The discovery shows unexpected flexibility in the system. Greater understanding could lead to better treatments and stem cell therapies for diabetes. Credit: Mark Huising/UC Davis
In people with type I diabetes, insulin-producing beta cells in the pancreas die and are not replaced. Without these cells, the body loses the ability to control blood glucose. Researchers at the University of California, Davis have now discovered a possible new route to regenerating beta cells, giving insight into the basic mechanisms behind healthy metabolism and diabetes. Eventually, such research could lead to better treatment or cures for diabetes.

"We've seen phenomenal advances in the management of diabetes, but we cannot cure it," said Mark Huising, assistant professor of neurobiology, physiology and behavior in the UC Davis College of Biological Sciences. "If you want to cure the disease, you have to understand how it works in the normal situation."

Huising is senior author on a paper on the work published April 4 in the journal Cell Metabolism.

Working with both laboratory mice and human tissue, Huising is studying how the cells in the islets of Langerhans in the pancreas work together to regulate blood glucose. In both mice and people, the islets contain beta cells, which detect glucose and secrete insulin, and other cell types including alpha cells that produce glucagon, a hormone that raises blood sugar. The opposite effects of insulin and glucagon enable the body to regulate blood sugars and store nutrients.

Type I diabetes is a disease with two parts. Firstly, the beta cells are killed by the body's own immune system, and then they fail to regenerate (or those that do are killed). An effective cure for type I diabetes would involve dealing with both problems.

Accepted dogma, Huising said, has been that new beta cells are generated by other beta cells dividing. But now by applying new techniques in microscopy, his team has discovered, scattered around the edges of the islets, another type of cell that looks a lot like an immature beta cell.

These new cells can make insulin, but don't have the receptors to detect glucose, so they can't function as a full beta cell. However, Huising's team was able to observe alpha cells in the islet turn into immature beta cells and then mature into real beta cells.

"There's much more plasticity in the system than was thought," Huising said.

Understanding Fundamentals of Metabolism and Diabetes

It's an exciting result for three reasons, Huising said. Firstly, this is a new beta cell population in both humans and mice that wasn't known before. Secondly, the new population could be a source to replenish beta cells killed off in diabetes. Finally, understanding how these cells mature into functioning beta cells could help in developing stem cell therapies for diabetes. Stem cells have the potential to develop into a wide range of other cells. So far, attempts to grow real beta cells from stem cells have made great strides, but these efforts have not yet reached their full potential because they get hung up at an earlier immature stage.

This basic understanding of cells in the islets could also help in understanding type II diabetes, where beta cells do not die but become inactive and no longer secrete/release insulin.

"JDRF is proud to have supported Dr. Huising in this work and extremely excited about the results shown in the paper. The concept of harnessing the plasticity in the islet to regenerate beta cells has emerged as an intriguing possibility in recent years," said Andrew Rakeman, Ph.D., director of discovery research at JDRF. "The work from Dr. Huising and his team is showing us not only the degree of plasticity in islet cells, but the paths these cells take when changing identity. Adding to that the observations that the same processes appear to be occurring in human islets raises the possibility that these mechanistic insights may be able to be turned into therapeutic approaches for treating diabetes."

'Crosstalk' gives clues to diabetes
by UC Davis

Sugar levels are managed by interactions between cells of the Islets of Langerhans in the pancreas. The hormone urocortin (green) is produced and stored in the same cells as insulin in the islets. Cells that make glucagon, which works to raise blood sugar, are stained red. Credit: Mark Huising, UC Davis
Sometimes, listening in on a conversation can tell you a lot. For Mark Huising, an assistant professor in the Department of Neurobiology, Physiology and Behavior at the UC Davis College of Biological Sciences, that crosstalk is between the cells that control your body's response to sugar, and understanding the conversation can help us understand, and perhaps ultimately treat, diabetes.

Huising's lab has now identified a key part of the conversation going on between cells in the pancreas. A hormone called urocortin 3, they found, is released at the same time as insulin and acts to damp down insulin production. A paper describing the work appears online on June 15 in the journal Nature Medicine.

"It's a beautiful system," Huising said. "It turns out that there is a lot of crosstalk going on in the islets to balance insulin and glucagon secretion. The negative feedback that urocortin 3 provides is necessary to tightly control blood sugar levels at all times."

Diabetes affects millions of Americans every year. Both forms of the disease—type 1, "juvenile" or "insulin-dependent" diabetes, and type 2 or "adult-onset" diabetes—occur when the body fails to regulate the level of sugar properly.

Diabetes is tied to structures called the Islets of Langerhans in the pancreas. Within the islets, beta cells make insulin. Increasing blood sugar stimulates insulin production, which causes the body's cells to pull sugar out of circulation.

The islets also house alpha cells, which make another hormone, glucagon, which acts on the liver to release more glucose into the bloodstream.

An islet of Langerhans with urocortin stained green in beta cells. Glucagon-making cells are stained red. Credit: Mark Huising.

An islet of Langerhans with urocortin stained green in beta cells. Glucagon-making cells are stained red. Credit: Mark Huising.

Urocortin 3 was originally identified as a hormone that is related to the signal in our brain that kick-starts our stress response. Instead, urocortin 3 is produced by islet beta cells and stored and released alongside insulin. In a series of experiments, Huising's group showed that urocortin 3 causes another cell type in the islets, delta cells, to release somatostatin, which turns down insulin production and acts as a natural brake on the release of insulin.

Urocortin 3 is reduced in laboratory animal models of diabetes and in beta cells from diabetic patients. Without urocortin 3, islets produce more insulin, but at the same time lose control over how much insulin they release.

By understanding how different cells and systems communicate to regulate blood sugar, Huising hopes to get a better understanding of what happens when this regulation goes wrong, leading to the different forms diabetes. Eventually this approach could lead to new ways to treat or prevent the disease.

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Diseases, Conditions, Syndromes
APRIL 21, 2015

New clues to treat juvenile diabetes
by UC Davis

UC Davis biologist Mark Hulsing will use the Hartwell Foundation grant to explore signals that cause new insulin-making cells to replace those lost in diabetes. (Gregory Urquiaga/UC Davis photo)
UC Davis Assistant Professor Mark Huising is a recipient of The Hartwell Foundation 2014 Individual Biomedical Research Award to support his early-stage research toward a cure for juvenile diabetes. Diabetes affects 10 percent of the entire United States population, including approximately a million children. Remarkably, 40 children every day receive the diagnosis of diabetes.

Huising, who works in the Department of Neurobiology, Physiology and Behavior at the UC Davis College of Biological Sciences, also holds an appointment in the Department of Physiology and Membrane Biology at the UC Davis School of Medicine. He joined UC Davis in November 2014 having previously worked at the Salk Institute in La Jolla, California. He is interested in how certain cells in the pancreas control the body's response to sugar in diabetes. Achieving a balance between reduction of elevated blood sugar levels and the need to prevent potentially fatal low sugar levels is critical to maintaining health.

The Hartwell Foundation award will provide $300,000 in direct cost over three years to support Huising's research looking at the biological signals and triggers affecting a small pool of cells in the pancreas that could be essential in regenerating control of blood sugar in this disease. The Individual Biomedical Research Award to Huising represents the ninth time a researcher from UC Davis has won such recognition from The Hartwell Foundation over the last seven years.

Islets, insulin and diabetes

Diabetes has been a prevalent health problem since ancient times. Two forms of the disease are known—Type 1, or "insulin-dependent" diabetes, and Type 2 diabetes, caused when the body fails to regulate the level of sugar properly, sending it either soaring high or dropping to very low levels.

In juvenile diabetes, the body's own immune system causes damage to a specialized region in the pancreas, called the islets of Langerhans, effectively rejecting the tissue. The damage is significant because the beta cells within the islets make insulin. Normally, increasing blood sugar stimulates insulin production, which causes the body's cells to pull sugar out of circulation. The islets also house alpha cells, which make another hormone, glucagon. When blood sugar falls, alpha cells make more glucagon, which causes the liver to break out stocks of glycogen and turn it into glucose.

New insight on insulin from immature cells

At diagnosis of diabetes, the body's immune system has already destroyed most beta cells and any ability to produce insulin. The remaining alpha cells build up and release glucagon, which causes a serious side-effect of juvenile diabetes. The majority of scientific strategies focus on means to prevent beta cell death and promote beta cell division. However, efforts to restore lost beta cells have been largely unsuccessful.

Huising has discovered that, in laboratory mice, immature beta cells may spontaneously arise from alpha cells. He proposes to identify the biochemical signals that switch alpha cells into beta cells and determine in human tissue whether such beta cells are adequately mature and functional. Huising's approach represents a shift in the current paradigm that after birth beta cells arise exclusively through the division of existing beta cells.

If successful, Huising will harness the intrinsic potential for beta cell regeneration that exists within pancreatic islets. This approach has the benefit of blocking a serious side effect of juvenile diabetes and represents a potential path to a cure for the disease.

Biomedical research that benefits children

"The Hartwell Foundation has a strong commitment to providing financial support to stimulate discovery in early-stage, innovative biomedical research that has potential to benefit children of the United States," said Fred Dombrose, president of The Hartwell Foundation. "Mark Huising typifies the innovative, young investigator we seek to fund. We want to make a difference."

Top Ten Center designation

In addition to the individual award, The Hartwell Foundation designated UC Davis as one of its Top Ten Centers for Biomedical Research for the fifth consecutive year.

In selecting each research center of excellence, The Hartwell Foundation takes into account the shared values the institution has with the foundation relating to children's health, the presence of an associated medical school and biomedical engineering program, and the quality and scope of ongoing biomedical research.

The foundation also considers the institutional commitment to support collaboration, provide encouragement, and extend technical support to the investigator, especially as related to translational approaches and technology transfer that could promote rapid clinical application of research results.

Type 2 diabetes: Understanding regulation of sugar levels for better treatment
by Institut National de la Sante et de la Recherche Medicale

Human islet of Langerhans (0.3 mm diameter) with alpha cells stained red and beta cells stained green. Credit: © Inserm Valery Gmyr
Individuals with type 2 diabetes, who are resistant to insulin, have an excess blood glucose level, which they are now trying to reduce using a new class of diabetes drugs known as the gliflozins. These new drugs lower the sugar level but also produce a paradoxical effect, leading to the secretion of glucagon, a supplementary source of glucose. Joint research units 1190, "Translational Research for Diabetes," (University of Lille, Inserm and Lille Regional University Hospital), directed by François Pattou, and 1011 "Nuclear Receptors, Cardiovascular Diseases and Diabetes," directed by Bart Staels, describe a new mechanism that controls glucagon secretion in humans, making it possible to elucidate this phenomenon and suggesting a modification of this new type of treatment.

These results, obtained in Lille at the EGID (European Genomic Institute for Diabetes) Laboratory of Excellence, are published in the journal Nature Medicine on 20 April 2015.

The team directed by François Pattou is developing innovative therapies to control the more severe forms of diabetes, a disorder characterised by a high blood sugar levels, i.e. chronic hyperglycaemia. To treat type 1 diabetes, the laboratory is conducting projects based on the production of human islets, which are transplanted into patients. Islet transplantation restores production of insulin, the hormone that controls the level of sugar by storing it when its level in the blood is too high. Analysis of human islets destined for transplantation makes it possible to evaluate the cells and thus improve transplantation. It was in this context that the research team discovered a new mechanism for controlling glucagon secretion in humans, a mechanism that explains a side-effect of a new class of diabetes drugs used to treat type 2 diabetes associated with obesity and characterised by insulin resistance.

When the cells detect a low sugar level (e.g. during fasting), an increase in blood sugar level is required to provide the energy needed by the body. This involves another hormone, glucagon, the role of which is to stimulate sugar production by the liver in order to restore the blood glucose levels to normal as quickly as possible. This hormone, secreted by the alpha cells in the islets of Langerhans in the pancreas, has been somewhat forgotten compared to insulin, which is produced by the beta cells to stimulate storage of sugar. It is, however, an essential part of the physiopathology of diabetes.

In this study, the researchers discovered that a glucose cotransporter, SGLT2, known to reabsorb glucose in the kidney, is present in the alpha cells, and controls glucagon secretion. By measuring the expression of the gene for this transporter in the islets of diabetic donors (type 2), they observed a reduction in SGLT2 expression and an increase in glucagon expression compared with the islets of healthy subjects. This result was confirmed in mice with type 2 diabetes. As they became increasingly obese, expression of the cotransporter declined.

Unexpectedly, by revealing this mechanism, the researchers have explained the paradoxical increase in glucagon level observed in patients using a new class of diabetes drugs, the gliflozins, marketed in the United States and the United Kingdom. This class of drugs targets the glucose transporter located in the kidney, preventing the reabsorption of excess glucose in diabetics and its partial elimination in the urine.

"The diabetes treatment dapagliflozin, by blocking the SGLT2 receptor, stimulates the alpha cells and increases glucagon secretion," explains François Pattou.

This unexpected effect might at least partially limit the hypoglycaemic effect of this diabetes treatment, and, for the researchers, justifies the simultaneous administration of other drugs that limit glucagon secretion, such as the sulfonylureas or GLP-1 analogues. Before it is marketed in France, which is expected in the next few months, this discovery might enable patients receiving this treatment for type 2 diabetes to optimise its efficacy.

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Diabetes
FEBRUARY 20, 2015

Diabetes drug could protect against low blood sugar levels by stimulating insulin production in the body
by Lund University

DPP-4 inhibitors are a group of drugs used to treat type 2 diabetes that lower high blood sugar levels by stimulating insulin production in the body. Researchers at Lund University in Sweden have now discovered that DPP-4 inhibitors are also effective against low blood sugar levels. The study, which was carried out on mice, has been published in the journal Diabetologia.

"If these inhibitors also prove effective in humans against low blood sugar, then this supports the idea that the area of application of these drugs could be broadened to include persons with diabetes that is difficult to control and suffer from frequent hypoglycaemias", said Siri Malmgren, a researcher at Lund University.

Blood sugar levels that are either too high or too low over a long period of time can cause serious harm to the body. Hypoglycaemia (low blood sugar) can occur in people with diabetes when they have eaten too little or after strenuous physical activity, as well as when they have taken too much insulin. It is an unpleasant condition with symptoms including heart palpitations and dizziness that can lead to a life-threatening 'insulin coma'. However, fatalities are extremely rare.

Normally, the body's own defence against hypoglycaemia is the hormone glucagon, which stimulates the liver to produce sugar and thus raise blood sugar levels. For those with diabetes, this regulation process doesn't work, leading to an increased risk of developing hypoglycaemia.

"In order to be able to offer people with diabetes more reliable treatment, it is important that their medication supports the body's own defences against hypoglycaemia", said Siri Malmgren, who conducted the study.

The researchers have therefore investigated whether DPP-4 inhibitors (Januvia, Galvus and others), an existing class of diabetes drugs could fulfil this function.

"One of the advantages of DPP-4 inhibition as a treatment for diabetes is the very low risk of hypoglycaemia. Through Dr Malmgren's important work, a fundamental new principle for this has been identified. We are now beginning to understand why DPP-4 inhibitors reduce the risk of this serious side effect", said Professor Bo Ahrén, the principal investigator for the study.

Mice treated with DPP-4 inhibitors were seen to have much better protection against hypoglycaemia than mice that were not given DPP-4 inhibitors. Their own production of glucagon also increased.

DPP-4 inhibitors stimulate the body's own insulin production - which lowers blood sugar - and work by raising the levels of another hormone - GIP - that is secreted in the intestines when we eat. Giving mice high doses of this hormone also protected them against hypoglycaemia and increased their glucagon levels.

"We believe that DPP-4 inhibitors not only lower blood sugar but also provide direct protection against hypoglycaemia, at least in mice, and that they do this by increasing levels of the hormones GIP and glucagon", said Siri Malmgren.

The researchers also reached the conclusion that GIP, which has previously been considered to lower blood sugar, in fact normalises blood sugar levels.

"Our findings could lead to new areas of application for existing drugs. We don't know all there is to know about the medicines we have, and once we have full insight into their mechanisms of action we can use them more effectively.

Scientists identify key control for blood glucose levels which could improve diabetes treatment
by Joanne Milne, University of Aberdeen

For people suffering from diabetes, managing blood sugar can be like walking a tightrope - if too high they run the risk of serious long term complications such as blindness, kidney failure, limb gangrene and premature heart disease, but allow it to drop too low and it can lead to a loss of consciousness which could be fatal.

Now a team of scientists from the UK and USA, has taken a major step forward in understanding how the brain senses low glucose levels and triggers responses to deal with this, which could help clinicians to devise new strategies to help control diabetes more safely.

They have identified a completely novel and hitherto unsuspected pathway buried deep within a region of the brain called the parabrachial nucleus. Here they found that a brain hormone, cholecystokinin (CCK), is a crucial sensor of blood glucose levels and orchestrates responses around the body when levels drop too low.

Professor Lora Heisler, from the University of Aberdeen Rowett Institute of Nutrition and Health, said: "It is remarkable to find that such an incredibly small set of cells in the brain play such an important role in maintaining normal glucose levels."

Dr Martin Myers, from the University of Michigan, said "We knew that CCK cells in the brain modify things like appetite and anxiety but they had previously been overlooked in terms of any link to blood sugar levels.

"The discovery of the important function of this brain hormone raises the possibility of using drugs targeting the CCK system to boost defences against hypoglycaemia, the clinical syndrome that results from low blood sugar. This can be extremely serious and in the most severe cases can lead to seizures, unconsciousness, brain damage and even death."

Professor Heisler and Dr Myers collaborated with colleagues from the universities of Aberdeen, Michigan, Cambridge, Edinburgh and Chicago to complete the study and their findings are now published in the journal Nature Neuroscience.

Professor Heisler said the identification of the role played by CCK could be of particular significance to around 20% of patients with diabetes who suffer from regular severe debilitating episodes brought on by low blood sugar.

"To allow glucose to enter the cells and provide the body with the energy it needs to carry out all basic functions, insulin is needed," Professor Heisler added.

"For those with diabetes, the effects of insulin on the body are drastically diminished, either because the pancreas doesn't produce enough of it (type 1 diabetes) and/or because cells are less responsive to it (type 2 diabetes).

"As a result, glucose can build up in the bloodstream and may reach dangerously high levels (hyperglycemia) which can result in serious long term complications such as blindness, kidney failure, limb gangrene and amputation and premature heart disease.

"To correct this problem, diabetics take insulin or other drugs designed to lower blood sugar levels but if they take too much insulin relative to the amount of glucose in their bloodstream, it can cause your blood sugar level to drop too low, resulting in hypoglycaemia.

"When patients suffer repeated bouts of hypoglycaemia they can develop 'unawareness' which means they find it difficult to detect symptoms that their blood sugar levels are falling and it is this group particularly that we hope could benefit from our findings in regard to the role played by CCK."

Dr Myers was the lead researcher in the study and now hopes to apply their findings in a clinical environment.

He said: "When blood sugar levels drop, a cascade of events takes place within the body which should boost it back up to normal levels but we did not know what triggered this chain of events.

"By identifying and understanding the basic machinery – CCK – that is organising and orchestrating this cascade of events, the more we can use that mechanism to help treat this disease.

"Further research is now needed to look at how we can target the CCK system as well as the cells upon which CCK acts to prevent or treat hypoglycaemia."

Gut hormone has 'remote control' on blood sugar

A gut hormone first described in 1928 plays an unanticipated and important role in the remote control of blood sugar production in the liver, according to a report in the August 6th Cell Metabolism, a Cell Press publication. What's more, the researchers show that rats fed a high-fat diet for a few days become resistant to the glucose-lowering hormone known as cholecystokinin (CCK).

"We show for the first time that CCK from the gut activates receptors to regulate glucose levels," said Tony Lam of the University of Toronto. "It does so via a gut-brain-liver neuronal axis."

Researchers already knew that CCK levels rise in the upper intestine in response to nutrients such as lipids to lower food intake, Lam explained. Now, his team shows that the CCK hormone binds local receptors on nerves of the small intestine, sending a powerful signal to the brain. The brain in turn tells the liver to stop producing glucose.

Lam said his group described the gut-brain-liver circuitry in a paper published last year. The new study shows that it is CCK that acts as the trigger.

A primary increase of CCK-8, the biologically active form of CCK, in the upper intestine lowers glucose production independently of any change to circulating insulin levels, they found. CCK-8's effects depend on activation of CCK-A receptors and the signals they send to the brain and on to the liver, where glucose production slows. Those effects of the hormone begin to fail early in the onset of high-fat diet-induced insulin resistance, they report.

The findings suggest that CCK resistance, like insulin resistance, might be a key contributor to the high blood sugar that often comes with a high-fat diet. It also suggests that drugs targeting the CCK receptors in the gut may hold promise for therapy. That's key, Lam said, because such gut-targeted drugs might be expected to have fewer side effects than currently available diabetes drugs that work directly on the liver.

"This raises the possibility that we might be able to tap into the circuitry [to lower blood sugar]," Lam said. "At least now we know where to start."

Drug combinations that could increase sensitivity to both insulin and CCK might better combat diabetes than either could alone, he added. While the magnitude of CCK's influence over glucose levels relative to the effects of insulin aren't yet known, Lam said it's now clear both are important and neither works properly in the case of diabetes or obesity.

The researchers further suggest that CCK's role in the gut might somehow explain why people often show improvements in their blood sugar levels following gastric bypass surgeries, even before they lose any weight.

"Since we described that duodenal CCK normally triggers a gut-brain-liver axis to lower glucose production but fails to do so in high-fat fed rodents, we propose that duodenal bypass surgeries improve glucose tolerance in diabetes and obesity partly because the surgery bypasses an acquired defect involving duodenal CCK resistance in response to high-fat feeding," they wrote. Further studies are needed to explore that notion.

Potential drug target identified for diabetes by studying novel gut-brain-liver circuit
Scientists at the Toronto General Hospital Research Institute have discovered a novel signaling pathway between three organs – the gut, the brain, and the liver – which lowers blood sugar when activated.

A team led by Dr. Tony Lam used a rat model to discover that fats can activate a subset of nerves in the intestine, which then send a signal to the brain and subsequently to the liver to lower glucose or sugar production. But eating a high-fat diet for just three days can interfere with this signal, disabling it so that it does not signal the other organs to lower blood glucose levels.

The research was published in a paper entitled, “Upper intestinal lipids trigger a gut-brain-liver axis to regulate glucose production” as an advance on-line publication of the international science journal Nature.

“This is a new approach in developing more effective methods to lower glucose or blood sugar levels in those who are obese or have diabetes,” said Dr. Lam, who holds The John Kitson McIvor (1915 – 1942) Chair in Diabetes Research at the University Health Network and University of Toronto. Currently, those with diabetes lower their glucose through diet, exercise, anti-diabetic tablets or insulin injections (usually several times a day) and must regularly monitor blood glucose levels. High glucose levels can result in damage to eyes, nerves and kidneys and increase the risk of heart attack, stroke, blindness, erectile dysfunction, foot problems and amputations. Many laboratories around the world are in a race to find alternative and effective ways in which to lower glucose levels because of the severe complications which can result from high sugar levels.

“We already knew that the brain and liver can regulate blood glucose levels, but the question has been, how do you therapeutically target either of these two organs without incurring side effects?” noted Dr. Lam, who is also an Assistant Professor of Physiology and Medicine at the University of Toronto. “We may have found a way around this problem by suggesting that the gut can be the initial target instead. Much like a remote control device, the gut is able to relay a signal to the brain which in turn signals the liver to lower glucose production. If new medicines can be developed that stimulate this sensing mechanism in the gut, we may have an effective way of slowing down the body’s production of sugar, thereby lowering blood sugar levels in diabetes.”

Dr. Lam emphasized that it will take a number of years of experimental work to determine whether this approach is effective and safe in humans who have diabetes.

More than two million Canadians have diabetes. “Diabetes is an epidemic in Canada and around the world and its numbers are continuing to increase at an alarming rate, consuming our precious health care resources,” says Dr. Gary Lewis, Head of the Division of Endocrinology and Metabolism at the University Health Network and Mount Sinai Hospitals in Toronto and Professor of Medicine and Physiology at the University of Toronto. “We have good evidence from clinical trials which shows that lowering blood glucose levels towards normal in those who develop diabetes has a major impact in preventing its devastating complications, so it is critical that we learn how to control these levels in the most effective and least invasive ways possible. Dr. Lam’s work reveals a new regulatory circuit which provides novel sites and targets to lower these levels in diabetes and obesity.”

Dr. Richard Weisel, Director of the Toronto General Research Institute (TGRI), Professor and Chairman of Cardiac Surgery at the University of Toronto, welcomes any potential interventions which can help lower blood sugar levels. “Studies have shown that people with very high blood glucose levels are more likely to die from heart disease, so anything that we can discover to help lower these levels would help in decreasing the progression of and mortality from cardiovascular disease.”

"Tony's discovery represents an exciting breakthrough that could eventually lead to new ways to treat diabetes," observed Dr. Diane Finegood, Scientific Director of the Institute of Nutrition, Metabolism and Diabetes, part of the Canadian Institutes of Health Research (CIHR). "I am pleased that CIHR played a major role in funding this research".

Working with rats, Dr. Lam and colleagues designed and performed a series of elegant experiments which showed for the first time that the lipids or fats which enter the small intestine trigger the afferent neuronal signal to the brain which then sends signals to the liver to lower glucose production and blood glucose levels in as little as fifteen minutes. No drop in levels occurred when nerves were cut or blocked between the gut and the brain or between the brain and the liver. The trigger to lower glucose was also disabled when rats were fed a high-fat diet for three days prior to the experiment, a finding which may suggest that those who eat a high fat diet lose this beneficial signaling pathway.

Source: Canadian Institutes of Health Research

Study offers insights on how the timing of dinner and genetics affect individuals' blood sugar control
by Massachusetts General Hospital

Credit: CC0 Public Domain
Blood sugar control, which is impaired in individuals with diabetes, is affected by various factors—including the timing of meals relative to sleep as well as levels of melatonin, a hormone primarily released at night that helps control sleep-wake cycles. In research published in Diabetes Care, a team led by investigators at Massachusetts General Hospital (MGH), Brigham and Women's Hospital (BWH) and the University of Murcia in Spain conducted a clinical trial to look for connections between these two factors.

"We decided to test if late eating that usually occurs with elevated melatonin levels results in disturbed blood sugar control," says senior author Richa Saxena, Ph.D., a principal investigator at the Center for Genomic Medicine at MGH.

For the randomized crossover study that included 845 adults from Spain, each participant fasted for eight hours and then for the next two evenings had first an early meal and then a late meal relative to their typical bedtime. The investigators also analyzed each participant's genetic code within the melatonin receptor-1b gene (MTNR1B) because previous research has linked a variant (called the G-allele) in MTNR1B with an elevated risk of type 2 diabetes.

"In natural late eaters, we simulated early and late dinner timing by administering a glucose drink and compared effects on blood sugar control over two hours," explains Saxena. "We also examined differences between individuals who were carriers or not carriers of the genetic variant in the melatonin receptor."

The team found that melatonin levels in participants' blood were 3.5-fold higher after the late dinner. The late dinner timing also resulted in lower insulin levels and higher blood sugar levels. (This connection makes sense because insulin acts to decrease blood sugar levels.) In the late dinner timing, participants with the MTNR1B G-allele had higher blood sugar levels than those without this genetic variant.

"We found that late eating disturbed blood sugar control in the whole group. Furthermore, this impaired glucose control was predominantly seen in genetic risk variant carriers, representing about half of the cohort," says lead author Marta Garaulet, Ph.D., a professor of physiology and nutrition in the Department of Physiology at the University of Murcia.

Experiments revealed that the high melatonin levels and carbohydrate intake associated with late eating impairs blood sugar control through a defect in insulin secretion.

"Our study results may be important in the effort towards prevention of type 2 diabetes," says co-senior author Frank A.J.L. Scheer, Ph.D., MSc, director of the Medical Chronobiology Program at BWH. "Our findings are applicable to about a third of the population in the industrialized world who consume food close to bedtime, as well as other populations who eat at night, including shift workers, or those experiencing jetlag or night eating disorders, as well as those who routinely use melatonin supplements close to food intake."

The authors note that for the general population, it may be advisable to abstain from eating for at least a couple of hours before bedtime. "Genotype information for the melatonin receptor variant may further aid in developing personalized behavioral recommendations," says Saxena. "Notably, our study does not include patients with diabetes, so additional studies are needed to examine the impact of food timing and its link with melatonin and receptor variation in patients with diabetes."

Melatonin and mealtime: Common genetic difference could put some at greater risk of diabetes
by Brigham and Women's Hospital

Credit: Darren Lewis/public domain
Researchers from Brigham and Women's Hospital (BWH) and the University of Murcia, Spain, have shed new light on why people who carry a common genetic mutation may be more at risk for developing type 2 diabetes. By carefully studying healthy subjects, researchers were able to chart the effect of melatonin supplements on blood sugar control. Their results, reported in Metabolism, suggest that taking melatonin close to mealtimes may put people with a common genetic variant more at risk.

"Our work is the first to show that a person's genetic profile could impact their ability to tolerate glucose when they take melatonin," said co-corresponding author Frank Scheer, PhD, associate professor of medicine at Harvard Medical School and the Director of the Medical Chronobiology at BWH.

"Our results suggest that we may need to exert caution when taking melatonin close to meal times, especially in carriers of the risk variant," said co-corresponding author Marta Garaulet, PhD, a full professor of Physiology at the University of Murcia.

As many as 50 percent of people of European ancestry carry this genetic variation in MTNR1B, a gene that encodes a melatonin receptor. Previous studies have found that this mutation increases a person's risk of diabetes, but exactly how and why it influences blood sugar control has remained poorly understood and has mostly been studied during the daytime, when naturally occurring melatonin concentrations are very low.

Scheer, Garaulet and their colleagues studied members of a female rugby team at the University of Murcia to investigate the effects of taking melatonin supplements on blood sugar levels. By looking at a small group of similar subjects, the research team could narrow in on the effects of melatonin and limit other possible causes of differences in results. Each recipient received either a dose of melatonin or a placebo in the morning (9 a.m.) and evening (9 p.m.), followed by a large dose of glucose, a so called oral glucose tolerance test. Blood samples were taken before and at 30-minute intervals after they received the glucose doses for the next two hours.

Of the 17 participants, 11 were carriers of the genetic risk variant and six were not. The research team found that in the morning, the effects of melatonin on ability to control blood sugar levels differed significantly between the two groups, finding that the carriers' ability to control blood sugar levels was six times worse than non-carriers'. In the evening, no significant differences were found between the two groups. The absence of the effect in the evening may have been due to a limited sample size.

"Our data suggest that when subjects take melatonin, the genetic risk variant in MTNR1B causes a much greater change in glucose tolerance in carriers compared to non-carriers, even in people who are not obese and not diabetic," said Scheer. "Our results suggest that it may be important to take genetics into account when thinking about timing of food consumption and melatonin administration." The team notes that further, large-scale studies will be needed in vulnerable populations before clinical recommendations can be made.

Gene associated with diabetes risk suggests link with body clock

New research shows a link between the body clock and diabetes.
A connection between the body clock and abnormalities in metabolism and diabetes has been suggested in new research by an international team involving the University of Oxford, the Wellcome Trust Sanger Institute and the MRC Epidemiology Unit in Cambridge.

The researchers have identified a gene involved in the way the body responds to the 24 hour day-night cycle that is strongly linked to high blood sugar levels and an increased risk of type 2 diabetes. The results of the genome-wide association scan are published in Nature Genetics.

‘We have extremely strong, incontrovertible evidence that the gene encoding melatonin receptor 1B is associated with high fasting glucose levels and increased risk of type 2 diabetes,’ says Professor Mark McCarthy of the Oxford Centre for Diabetes, Endocrinology and Metabolism at the University of Oxford.

Melatonin is a hormone that is strongly tied to control of our sleep-wake cycles, with concentrations in the blood peaking at nighttime and dipping during the day. As a result, melatonin is implicated in conditions like jetlag and sleep disorders.

Disrupted sleep patterns are known to be associated with a range of health problems including metabolic disorders like diabetes, but it is not understood how they are connected. In identifying a link between a melatonin receptor and blood sugar levels, this study provides genetic evidence that mechanisms controlled by our body clock are connected to the machinery that keeps us metabolically healthy. It seems likely that the action of melatonin on the pancreas is being disturbed in this case, the researchers suggest.

The international research collaboration combined ten genome-wide association scans involving a total of over 36,000 individuals of European descent. A variant in the gene encoding melatonin receptor 1B (MTNR1B) showed a rise of 0.07 mmol/l in fasting glucose level on average and a 9% increase in risk of type 2 diabetes for each copy of the gene variant inherited from a parent.

‘High fasting glucose levels are early markers of diabetes and this observation provides important clues about the possible mechanisms linking genes to diabetes risk,’ says Professor Nick Wareham, Director of the MRC Epidemiology Unit in Cambridge.

Other genes have previously been shown to be associated with high blood sugar levels, but have not shown an increase in diabetes risk. The melatonin receptor found in this genome-wide study is the first gene to be linked to both high blood sugar and increased risk of diabetes.

‘Although levels of glucose in the blood are used to diagnose diabetes, most of the genes previously associated with high glucose levels do not increase risk of diabetes,’ says Dr Inês Barroso from the Wellcome Trust Sanger Institute. ‘We have found a variant – a G in the genome in place of a C – in MTNR1B. This single-letter change influences both sugar levels and diabetes. This remarkable result should allow us to gain new insight into this problem.’

Source: University of Oxford

Physical activity protects against type 2 diabetes by modifying metabolism
by University of Eastern Finland

Figure 1. The association of physical activity (PA) changes with glucose and insulin concentrations, insulin sensitivity, and insulin secretion in 5867 participants without diabetes at baseline, subjected to oral glucose tolerance tests both at baseline and follow-up visits. The effect sizes (β, SE) are given as the standardized mean differences for participants who decreased their PA (PADec) or increased their PA (PAInc) compared to the reference category of no changes in their PA (PA0). The p-values were adjusted for age, follow-up time, corresponding metabolic trait at baseline, BMI, smoking, alcohol consumption, and PA at baseline. Credit: DOI: 10.3390/metabo12010069
Regular physical activity significantly changes the body's metabolite profile, and many of these changes are associated with a lower risk of type 2 diabetes, a new study from the University of Eastern Finland shows. The study population included more than 7,000 men who were followed up for eight years. Men in the highest physical activity category had a 39% lower risk of type 2 diabetes than men who were physically inactive. Physical activity was associated with the levels of a total of 198 metabolites, i.e., compounds formed as a result of the body's metabolism, and increased physical activity had an impact on some of the same metabolites that have previously been associated with a health-promoting diet. In addition, the study showed that increased physical activity improves insulin secretion.

A total of 1,260 metabolites were analyzed from the study participants' fasting glucose samples. The association of physical activity with the metabolite profile hasn't been studied this comprehensively nor in such an extensive cohort before. Indeed, published in Metabolites, this study is the first to establish an association between many metabolites and physical activity.

The researchers investigated the association of physical activity with metabolite profile, insulin sensitivity, insulin secretion and risk of type 2 diabetes in men participating in the METabolic Syndrome In Men (METSIM) study. None of the participants had diabetes at the onset of the study. A physical activity questionnaire was conducted among the participants at the onset of the study and again eight years later, and they also underwent an oral glucose tolerance test and had their metabolites analyzed from a fasting glucose sample.

Men were classified into four categories based on their physical activity: those who were physically inactive, those who were physically active only occasionally, those who were physically active regularly but no more than twice a week, and those who were physically active regularly at least three times a week. The duration of a single session of physical activity was defined as at least 30 minutes.

Physical activity was associated with the levels of a total of 198 metabolites. Among other things, physical activity changed the levels of several lipids in a manner that in previous studies has been associated with a lower risk of type 2 diabetes. In previous studies, a health-promoting diet has also been observed to have some similar associations with unsaturated fatty acid levels, for example. As completely new metabolic biomarkers associated with physical activity, the researchers identified in particular steroids, amino acids, imidazoles, carboxylic acids, and hydroxy acids.

During the follow-up, the risk of developing type 2 diabetes was 39% lower for men who were physically the most active, and 30% lower even for men who were physically active no more than twice a week, when compared to men who were physically inactive. Lower fasting glucose and insulin levels, and better insulin sensitivity and insulin secretion, were observed in men who increased their physical activity during the follow-up.

The association of physical activity with insulin secretion has remained unclear, despite several studies on the matter. The study published now confirms that increased physical activity improves insulin secretion.

Moderate-to-vigorous physical activity and less sitting reduce the risk of diabetes in older adults
by University of Oulu

Credit: Unsplash/CC0 Public Domain
According to a recent study, moderate-to-vigorous physical activity and less sedentary time improve glucose metabolism and reduce the risk of type 2 diabetes in older adults. Based on the results, it is important to encourage older adults to avoid sedentary time and increase moderate-to-vigorous physical activity to improve their glucose metabolism.

The study is part of the population-based Oulu1945 survey conducted in 2013–2015 by the University of Oulu and Oulu Deaconess Institute's Department of Sports and Exercise Medicine, Finland. The survey involved a total of 660 Oulu residents born in 1945 and between the ages of 67 and 69, at that time. Physical activity and sedentary time were measured with a wrist-worn accelerometer for a period of two weeks, and the glucose metabolism was examined using an oral glucose tolerance test. The subjects were divided into the following four profiles based on the amount of moderate-to-vigorous physical activity and sedentary time: "couch potatoes," "light movers," "sedentary actives" and "actives."

"Active" older adults had a lower incidence of type 2 diabetes and prediabetes than older adults in the 'couch potatoes' profile, one in two of whom were found to have a glucose metabolism disorder. The blood glucose and insulin concentrations in the 'active' profile were lower throughout the glucose tolerance test compared to those in the less physically active groups. Older adults in the 'active' profile had a better glucose tolerance and muscle insulin sensitivity than those in the 'couch potatoes' profile, both clear signs of a reduced risk of diabetes.

"Previous surveys have suggested a link between older adults' physical activity and glucose metabolism, but the use of the accelerometer in studies involving older adults has been negligible. In this study, we were able to make a distinction between moderate-to-vigorous physical activity and sedentary time through accelerometry and to then profile the subjects on that basis in different activity profiles. We analyzed the association between the physical activity profile and glucose metabolism, which is a new perspective. By the activity profiles, we can see that, from the point of view of glucose metabolism, physical activity alone is not enough: you should be active and potter about throughout the day," says researcher Miia Länsitie.

The risk of glucose metabolism disorders increases significantly in older age, making it essential to find ways to prevent diabetes in older adults. Based on this study, an active lifestyle, including moderate-to-vigorous physical activity and limited sedentary time, also promotes older adults' glucose metabolism and can play a significant role in preventing diabetes in older people.

"Older adults with long-term illnesses or functional limitations, who may find it impossible to achieve the recommended level of physical activity, should spend less time sitting down and more pottering about every day to enhance their glucose metabolism," Länsitie says.

Study shows active older adults have better physical and mental health
by American Cancer Society

Credit: CC0 Public Domain
Older adults with higher physical activity and lower sitting time have better overall physical and mental health, according to a new study from the American Cancer Society (ACS). The study, appearing in the journal, CANCER, suggests that higher amounts of regular moderate- to vigorous-intensity physical activity (MVPA) and lower duration of sedentary time is associated with higher global mental and physical health for older cancer survivors and older adults, in general.

With a rapidly aging population and nearly 16.9 million cancer survivors in the United States today, there is a need to identify strategies associated with healthy aging and improving quality of life for aging cancer survivors. Being physically active is related to several health benefits, and in this study, ACS investigators led by Dr. Erika Rees-Punia analyzed self-reported aerobic and muscle-strengthening physical activities, sitting time, and mental and physical health among nearly 78,000 participants in the ACS's Cancer Prevention Study II Nutrition Cohort. Participants (average age 78 years) included older cancer survivors up to 10 years post-diagnosis, and cancer-free adults.

The investigators found that regardless of cancer history, the differences in global mental and physical health between the most and least active, and the least and most sedentary, were clinically meaningful. These findings provide evidence for the importance of engaging in regular MVPA and decreasing sitting time as a reasonable non-pharmacologic strategy to improve quality of life in older men and women, with or without a prior cancer diagnosis. In fact, the recently published ACS physical activity guidelines recommend that adults get 150-300 minutes of moderate-intensity activity or 75-150 minutes of vigorous-intensity activity through the week, and to limit sedentary behaviors such as screen-based entertainment.

"The findings reinforce the importance of moving more and sitting less for both physical and mental health, no matter your age or history of cancer," said Rees-Punia. "This is especially relevant now as so many of us, particularly cancer survivors, may be staying home to avoid COVID-19 exposure, and may be feeling a little isolated or down. A simple walk or other physical activity that you enjoy may be good for your mind and body."

Replacing sitting time with physical activity associated with lower risk of death
by American Cancer Society

Credit: CC0 Public Domain
For those who get the least amount of physical activity, replacing a half hour of sitting time with physical activity was associated with up to a nearly 50% reduction in mortality, according to a new study from the American Cancer Society. The study, appearing in the American Journal of Preventive Medicine, suggests that replacing modest amounts of sitting time with even light physical activity may have the potential to reduce the risk of premature death among less active adults.

Regular moderate- to vigorous-intensity physical activity (MVPA) is associated with a lower risk of cardiovascular disease; certain cancers; and premature death. In addition, the amount of time spent sedentary-distinct from physical inactivity—is associated with a higher risk of death and disease. That may be a result, at least in part, from sedentary behavior displacing physical activity.

Most previous studies have explored the potential effect of sedentary time without considering the physical activity it displaces, leaving a gap in the understanding of the issue. To explore further, investigators led by Erika Rees-Punia, Ph.D., analyzed self-reported sitting time, light physical activity, and moderate/vigorous physical activity among 92,541 participants in the ACS's Cancer Prevention Study II Nutrition Cohort.

The analysis reviewed sedentary time and activity levels over 14 years. It found among those who were the least active at baseline (?17 minutes/day moderate to vigorous physical activity), replacing 30 minutes/day of sitting with light physical activity was associated with a 14% reduced risk of death, while replacement with moderate to vigorous physical activity was associated with a 45% reduced risk of death.

The investigators found similar but smaller associations among moderately active participants: replacing a half hour of sedentary time with light physical activity was associated with a 6% reduction in mortality among those who were moderately active; replacing 30 minutes of sitting time with moderate to vigorous physical activity was associated with a 17% mortality reduction in this group. However, for the most active (>38 minutes/day of MVPA), substitution of sitting time with light physical activity or MVPA was not associated with a reduction in mortality risk.

Participants reporting more moderate/vigorous physical activity were leaner, had a higher educational attainment, and were less likely to be current smokers. For all participants, sitting time largely included watching TV (39%) and reading (20%).

The study did have some limitations: it relied on self-reported physical activity and sitting time; it lacked information on certain activities of daily living (e.g., cleaning, self-care, cooking) that are particularly common for older adults. And participants were predominately white and educated, so may not represent the general U.S. population.

"These findings suggest that the replacement of modest amounts of sitting time with even light physical activity may have the potential to reduce the risk of premature death among less active adults," conclude the authors.

Behavioral intervention ups physical activity in T2DM
(HealthDay)—A behavioral intervention results in a sustained increase in physical activity and decrease in sedentary time among patients with type 2 diabetes, according to a study published in the March 5 issue of the Journal of the American Medical Association.

Stefano Balducci, M.D., from "La Sapienza" University in Rome, and colleagues enrolled 300 physically inactive and sedentary patients with type 2 diabetes to receive a behavioral intervention or standard of care for three years. One individual theoretical counseling session and eight biweekly theoretical and practical counseling sessions were provided each year to participants in the behavioral intervention group. In the standard care group, participants received only general physician recommendations.

Participants were followed for a median of 3.0 years. The researchers found that in the behavioral intervention and standard care groups, respectively, participants accumulated 13.8 and 10.5 metabolic equivalent-hours per week of physical activity volume, 18.9 and 12.5 minutes/day of moderate-to-vigorous intensity physical activity, 4.6 and 3.8 hours/day of light-intensity physical activity, and 10.9 and 11.7 hours/day of sedentary time. Throughout the study, the significant between-group differences were maintained; during the third year, the between-group difference in moderate-to-vigorous intensity physical activity decreased.

"This behavioral intervention strategy was successful in increasing physical activity volume by reallocating sedentary time to light-intensity physical activity and, to a lesser extent, moderate- to vigorous-intensity physical activity," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Once-yearly counseling tied to more physical activity in T2DM
(HealthDay)—Theoreti cal and practical once-yearly counseling for three years is associated with increased physical activity (PA) and reduced sedentary (SED) time in patients with type 2 diabetes, according to a study published online Aug. 18 in Diabetes Care.

Stefano Balducci, M.D., from La Sapienza University in Rome, and colleagues randomized 300 physically inactive and sedentary patients with type 2 diabetes to receive theoretical and practical counseling once yearly for three years (intervention group [INT]) or standard care (control group). The authors reported the four-month effects on objectively measured daily light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), and SED time, as well as cardiovascular risk factors.

The researchers observed increases in LPA and MVPA in both groups, and decreases in SED time, although the changes were significantly more marked in INT participants. In INT participants only there was a significant reduction in hemoglobin A1c (HbA1c). There was an association for an increase in LPA >0.92 hours/day and in MVPA >7.33 min/day, and a decrease in SED time >1.05 hours/day, with an average decrease of about 1 percent in HbA1c and with significant improvements in fasting glucose, body weight, waist circumference, and high sensitivity C-reactive protein. PA and SED time changes independently predicted improvement in HbA1c.

"Significant improvements in cardiometabolic risk profiles were observed in subjects experiencing the most pronounced changes in PA and SED time, even if below the recommended level," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Continuous subcutaneous insulin infusion bests injections in T2DM
(HealthDay)—For patients with type 2 diabetes and hemoglobin A1c (HbA1c) >8 percent following multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) is associated with a significantly greater reduction in HbA1c than MDI, according to a study published online April 4 in Diabetes, Obesity and Metabolism.

Muriel Metzger, M.D., from the Diabetes Clinic in Jerusalem, and colleagues examined factors associated with the decrease in HbA1c among patients receiving CSII in the OpT2mise randomized trial. Following MDI optimization, patients with type 2 diabetes and HbA1c >8 percent were randomized to receive six months of CSII (168 patients) or MDI (163 patients).

The researchers found that, compared with MDI, CSII produced a significantly greater reduction in HbA1c; the difference increased with baseline HbA1c. Higher baseline HbA1c, geographical region, higher education level, higher total cholesterol level, lower variability of baseline glucose valued on continuous glucose monitoring, and the decrease in average fasting self-monitored blood glucose at six months were the only factors significantly associated with decreased HbA1c in the CSII arm.

"These findings suggest that CSII offers an option to improve glycemic control in a broad range of type 2 diabetes patients in whom control cannot be achieved with MDI," the authors write.

The study was funded by Medtronic.

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What you need to know about monoclonal antibodies

First, we searched for effective methods to treat seriously ill patients with COVID-19. ICU teams across the country used drugs like remdesivir and treatments such as artificial ventilation to help thousands recover. Then, we anxiously awaited the development of a safe and effective COVID-19 vaccine. Now, we continue to strive to treat those who are at increased risk for severe illness from COVID-19, and monoclonal antibodies have been shown to play a key role.

Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight a particular infection, such as COVID-19. Research has shown that the risk of hospitalization or death was reduced by 85% among those who received sotrovimab, a monoclonal antibody that has been granted emergency use authorization by the U.S. Food and Drug Administration. Sotrovimab joins oral antiviral medications as one of the few treatments for mild to moderate COVID-19 that are effective against the omicron variant.

Studies have shown patients feel better and get back to work faster after receiving monoclonal antibodies. The administration of monoclonal antibodies also reduced the duration of symptoms in patients with COVID-19.

Who qualifies for monoclonal antibody treatment?
According to Dr. Ran Regev, a board-certified emergency medicine doctor affiliated with Sharp Chula Vista Medical Center, monoclonal antibodies are an appropriate treatment for people who are at least 12 years old and 88 pounds, and are at increased risk for severe illness from COVID-19. They must have recently tested positive for COVID-19 and be within 10 days of the onset of any COVID-19 symptoms, such as fever, cough, sore throat, headache, fatigue, muscle pain, stomach upset and loss of taste or smell.

People considered to be at high risk of severe COVID-19 illness include those who:

Are age 65 or older
Are overweight (body mass index over 25)
Are pregnant
Are currently receiving immunosuppressive treatment
Have the following conditions:
Chronic kidney disease
Type 1 or Type 2 diabetes
Weakened immune system
Cardiovascular disease or high blood pressure
Chronic lung disease
Sickle cell disease
Neurodevelopmental disorders
Medical-related technological dependence
“To qualify for treatment, a patient at risk for severe illness with laboratory-confirmed COVID-19 infection must have mild to moderate COVID symptoms and not require supplemental oxygen or hospitalization,” Dr. Regev says.

What happens during treatment?
Once a patient meets the criteria for treatment, Dr. Regev reports that the care team will discuss the risks, benefits and alternatives to monoclonal antibody treatment with them.

The antibodies are administered through a 30-minute infusion or injection. Some people may experience mild bruising or irritation at the infusion or injection site.

Patients will be monitored for signs of an allergic reaction for one hour after receiving the treatment. Though rare, reactions can include:

Fever
Chills
Nausea or vomiting
Headache
Shortness of breath
Low blood pressure
Wheezing
Swelling of the lips, face or throat
Rash or hives
Itching
Muscle aches
Dizziness
Can monoclonal antibodies replace the need for vaccination?
While monoclonal antibodies provide an effective means to prevent the development of severe COVID-19 in those who have already been infected, Dr. Regev says that vaccination remains the best way to prevent infection, severe symptoms, hospitalization and death. “I cannot stress enough the importance of vaccination,” he says.

In San Diego County, the hospitalization rate for people who are not vaccinated is three times higher than those who are fully vaccinated, and the death rate is four times higher. This supports Dr. Regev’s and colleagues’ continued — and confirmed — assertions that the COVID-19 vaccines available in the U.S. are safe and extremely effective.

“I encourage everyone who qualifies for vaccination to vaccinate themselves and to encourage their loved ones to do the same,” Dr. Regev says. “This will not only significantly reduce their chance of morbidity and mortality from COVID, but also will likely help in ending the pandemic.”

If you have been recently diagnosed with COVID-19, talk with your doctor about whether you qualify for monoclonal antibody treatment. The County of San Diego offers treatment at several Monoclonal Antibody Treatment Centers and reports there is ample supply of treatment available, which is available at no cost, regardless of health insurance or immigration status. Additionally, your doctor's referral is not required.

For information about monoclonal antibody treatment in San Diego, call 619-685-2500 or email COVIDtreatment@sdcou nty.ca.gov. Learn more about COVID-19 vaccination, testing and care resources at Sharp.

This story was updated in February of 2022.

Is our blood pressure rising due to the pandemic?
Feb. 18, 2022
Illustration of woman wearing a mask
Early in the pandemic, it was revealed that having high blood pressure, also called hypertension, put people at greater risk for having severe complications related to COVID-19. The heightened attention on blood pressure continued, and in December 2021, the American Heart Association reported that blood pressure levels have increased across the board for men and women during the past two years.

Experts attribute the rise to more people engaging in behaviors — fueled by the pandemic — that contribute to high blood pressure, such as eating processed food, which can lead to weight gain; increasing alcohol use; and decreasing exercise and physical activity. There is also the added factor of the elevated stress levels people have been experiencing during this time.

According to Dr. David Hall, a board-certified internal medicine doctor with Sharp Rees-Stealy Medical Group, the nationwide rise in blood pressure is hitting close to home too. Increasing numbers of patients in the San Diego area have been diagnosed with hypertension, some for the very first time.

“I have also noticed elevation of blood pressure in patients with previously controlled hypertension,” he says. “This is concerning because elevated blood pressure over time can lead to serious complications, including stroke, heart attack, heart failure and kidney failure.”

A rise in blood pressure can be gradual or it can rapidly spike. For patients susceptible to hypertension, risk factors that quickly elevate blood pressure include drinking more than two alcoholic drinks a day, eating a high-sodium diet, and dealing with acute and chronic stress.

Such stress can trigger an increase in blood pressure by raising levels of adrenaline and cortisol. Sleep disorders, such as sleep apnea, also contribute to high blood pressure.

Controlling hypertension with the help of your doctor
Dr. Hall recommends that if you experience a sudden increase in blood pressure to promptly contact your primary care doctor to rule out any secondary causes. You should have your blood pressure taken at every appointment. If the reading comes back as elevated, blood pressure should be retaken to verify the numbers.

If you have elevated blood pressure, there are several ways to monitor and control it:

Initial guidance — Your doctor can instruct you on how to take blood pressure recordings at home and make healthy lifestyle changes.
Follow-up — A follow-up visit should be scheduled for high blood pressure. Close contact should be maintained with your care provider until your hypertension is well controlled. Then, follow-up appointments every 6 months are recommended.
Medication and treatment — If your blood pressure remains high, your doctor might discuss treatment options with you, such as blood pressure medication.
Testing — Your kidney function will also be monitored with annual blood and urine tests.
Health coaching — If you have difficult-to-control blood pressure or need additional monitoring or education, Sharp offers health coaches who keep in contact with you and provide support, education and guidance.
Ways to lower blood pressure on your own
While medical intervention to treat high blood pressure is often necessary, dietary changes can also have an immense impact. “Lifestyle modification is crucial and is the backbone of all hypertension treatment,” confirms Dr. Hall.

He recommends switching to a DASH diet or Mediterranean diet. These are generally low in refined carbohydrates and sugar, rich in fruits and vegetables, and include a moderate amount of lean proteins, like chicken and fish, and healthy fats, such as olive oil, nuts and avocados.

In some studies, this type of diet has been shown to reduce blood pressure 5 to 10 points. Cutting back on sodium to no more than 1,500 milligrams a day can reduce blood pressure an additional 4 to 5 points.

Combined with a healthy diet, exercising for 90 to 150 minutes a week can also significantly lower blood pressure. These changes will often lead to weight loss, which also improves blood pressure. Stress reduction and limiting alcohol intake can also make a big difference.

Talk with your primary care doctor if you are concerned about your hypertension management. Together, you can come up with an appropriate plan to treat it, make lifestyle changes and reduce your risk of serious complications.

Relief in sight for pain-in-the-neck disks
Feb. 17, 2022
Julie Goecks of San Diego
Cervical disk replacement helped Julie Goecks regain full range of motion in her neck.

After, as she puts it, being “stuck looking forward” for years, Julie Goecks’ two degenerated disks are no longer a pain in the neck.

“When I wanted to turn my neck, I pretty much had to turn my whole body,” says Julie. “It was frozen in one spot, and I couldn’t turn from side to side, or even tip my head back.”

The neck, or cervical spine, includes the first seven disks of your spinal column. Damaged disks can greatly limit your mobility and quality of life — and can be very painful. Tissue damage in the disks creates what is called degeneration, and when inner disks squeeze through the outer disks, it is called a bulging or herniated disk.

In the past, treatment was limited to either fusion surgery, which simply stabilizes the spine, or the use of older-generation cervical replacement disks. These tended to be big and bulky and did not provide a full range of motion. Also, they were designed for patients who needed only one disk replaced.

Groundbreaking option provides relief
Today, however, a state-of-the-art replacement disk, called Mobi-C, stands apart. Its design mimics the natural motion of a healthy cervical spine, allowing people to get back to living their best life.

Dr. Ramin Raiszadeh is an orthopedic surgeon affiliated with Sharp Grossmont Hospital, who specializes in spine care and is a champion for cervical disk replacement using this technology.

“With a fusion, patients lose the ability to move that segment of their spine, putting a lot of strain on the disks above and below the fusion,” says Dr. Raiszadeh. “With the Mobi-C disk, patients are able to move their spine at the location of that new disk, and don’t have those issues with the adjacent disks that were a problem with the older technology.”

Mobi-C is also the first cervical disk to be approved by the FDA for use in patients who need multiple disk replacements. That’s what made Julie an ideal candidate for this technology.

When she first saw Dr. Raiszadeh, she had been living with her condition and physical limitations for years.

“He said, ‘I’m very confident you’ll feel much better after this procedure or I wouldn’t be recommending it,’” says Julie.

He was right. “Now, I can drive, tie my shoes, and do the normal day-to-day things we take for granted,” she says.

A return to activities after life-changing procedure
Dr. Raiszadeh wants to spread the word to patients that this option is out there. The procedure could allow them to avoid unnecessary fusion and, possibly, subsequent surgeries to those disks above and below the damaged one.

Cervical disk replacement is an option for patients who have tried conservative treatments, such as physical therapy and injections. However, patients with more than two damaged disks, osteoporosis or very severe neck pain are typically not ideal candidates.

For those patients fortunate enough to have the procedure, Dr. Raiszadeh says the difference is life-changing. Most can return to a desk job within a week after the procedure, and to all their favorite activities within three months.

Just ask Julie. Before her surgery, she remembers playing softball with her daughter and granddaughter but not being able to look straight up. She says she just kept her fingers crossed that she didn’t get knocked out by a fly ball.

“Now I can look up and, hopefully, catch the ball,” she says.

Top gadgets to reduce loneliness in older adults
Feb. 16, 2022
Man using tablet
Life can get busy with working, caring for children and running errands. It can become easy to forget the last time you checked in with the older adults in your life, such as family members, neighbors or senior acquaintances.

According to the U.S. Census Bureau, many older adults are struggling with loneliness, as nearly one-third live by themselves — that’s close to 14 million people. Life events, such as losing family and friends, and hearing and memory loss, put older adults at higher risk of isolation.

Loneliness and social isolation in older adults have been linked to serious health conditions. And as the pandemic continues, the persistent lack of connectivity can impact their mental health and well-being.

“Isolation of older adults is dangerous for many reasons, especially when it comes to mental health,” says Dan McNamara, program coordinator for the Senior Resource Centers at Sharp Grossmont Hospital. “People are social by nature. We have to remember that older adults are people too.”

Gadgets to stay connected
Relationships are important to everyone, as they can make a difference in happiness, physical health and lowering stress. Fortunately, some popular devices can help you stay close and connected with the older adults in your life when you are unable to be together in person. These include:

Smartphones or tablets — While many of us associate smartphones and tablets with younger people, older adults also recognize the benefits of these convenient communication tools. According to the Pew Research Center, 61% of people over age 65 use smartphones. Family and friends can share special moments by uploading photos and videos, as well as stay in touch through video chats.

Virtual reality — Seniors around the world are using virtual reality to help reduce loneliness and improve their mental health. Virtual reality tools can transport them to different places without leaving the comfort of home. The virtual reality experience also allows older adults to enjoy adventures with friends who live in another part of the country. They can enjoy experiences that may no longer be physically possible, such as riding a roller coaster, visiting a place they have never been to, or taking a trip down memory lane to their favorite places.

Robotics — Hearing the word “robots” may take an older adult back to Will Robinson’s adventures in “Lost in Space.” As seniors encounter social isolation and loneliness, many are rethinking the role of robotics in improving their mental health. Artificial intelligence, or AI, can be used to create a digital home companion for older adults that can respond to questions, initiate calls, monitor and analyze the person’s environment, as well as provide entertainment and emotional enrichment activities — effectively serving as a virtual personal assistant.

Monitoring systems — According to the National Council on Aging, over 80% of older adults have at least one chronic disease. Add to this list other common age-related issues, such as risk of falls, heart disease, stroke and Alzheimer’s disease, and monitoring systems can provide an extra sense of security. In the event of an emergency, these systems can receive alerts via a phone app. Some monitoring systems even include sensors that allow conversations with the person while they are being monitored.

Continued need for technology solutions
The demand for more solutions to minimize isolation among older adults will only grow as the number of people age 65 and older — as well as the number of adults living alone — increases. According to the Census Bureau, by 2034, there will be 77 million people age 65 and older, and just 76.5 million people under age 18. If the projections are correct, this will be the first time in U.S. history that older people will outnumber children.

However, according to McNamara, using technology might help us gain an advantage in caring for the increased number of older loved ones. “Whether that means a short visit on a video call or using a camera system as a second set of eyes and ears, we can show love to our older adults in a variety of ways. Connecting with them is one of the absolute best,” he says.

Walking together for good health
Feb. 8, 2022
Sharp Grossmont Center Mall Walkers
The Grossmont Mall Walkers look forward to their weekly group gathering at Grossmont Center.

On Saturday mornings at the Grossmont Center Food Court, you’ll find Daphne Miller and her bright smile, ready to welcome a group of friends in their athletic wear and laced-up sneakers. Armed with energizing music and cheerful encouragement, Daphne gets the group started with a warmup before they set out for their weekly walk at the shopping complex.

This lively group of older adults gathers weekly to participate in the Grossmont Mall Walkers program. Established more than three decades ago at the La Mesa mall — long before Zumba, CrossFit and kettlebell workouts became trendy — the program brings together individuals from all walks of life who seek cardiovascular exercise in a non-gym setting.

The free program, supported by the Senior Resource Center at Sharp Grossmont Hospital, not only promotes an active lifestyle, but also provides a social outlet for participants. According to Deborah Maddern, a participant in the walking program, the group is a great fit for her.

“I’m so glad I joined the group!” she says. “I recently celebrated turning 70, and I’ve been able to participate in this with ease, even after having surgery. I’m so glad I learned that this program was out there.”

With a walk and a smile
“Having this program essentially in our own backyard is fantastic,” says Dan McNamara, program coordinator at Sharp Grossmont’s Senior Resource Center. “Participants look forward to this every week.”

Daphne, who radiates positivity and has a degree in gerontology, says that the walkers inspire her. “This is very beneficial for their health — and it’s free,” she says. “The more you do for people, the more they feel connected.”

An avid member of the fitness classes for over seven years, Barbara Wallbank appreciates that anyone can participate in Daphne’s classes, no matter their skill level. “Even though I could be sleeping in late on a Saturday, I wake up early to come to her class because I enjoy the energy,” she says.

The Grossmont Mall Walkers meet every Saturday at 9 am in the food court at Grossmont Center in La Mesa. New walkers are always welcome.

Vegetables that get a bad rap
Feb. 15, 2022
Roasted potatoes
It’s no secret that vegetables are an important part of a healthy diet. Yet, some vegetables get a bad rap as being less healthy.

According to Lauren DeWolf, RD, a registered dietitian and wellness education specialist with Sharp Rees-Stealy’s Center for Health Management, certain vegetables might be more nutrient-dense than others. These vegetables tend to get all the attention as superfoods. However, every vegetable has something to offer nutritionally.

“Oftentimes, the processing and preparation method can have a big impact on the final nutritional profile of a vegetable choice,” she says.

DeWolf reports that although the following four vegetables often get a bad reputation, they don’t necessarily need to be eliminated from your diet:

Potatoes
You may have heard that you should eliminate white foods from your diet. Generally, this can help reduce the amount of refined, processed foods we eat, such as white sugars and white flours. However, this thinking doesn’t necessarily apply in the same sense to vegetables. Cauliflower, garlic, onion, turnips and potatoes are all white vegetables and have many redeeming qualities.

Potatoes offer nutritional benefits, such as fiber, protein, potassium, vitamin C and phytonutrients. When we peel and deep fry potatoes, the final result is a calorie-dense food that is difficult to moderate. However, when we prepare potatoes in a manner that minimizes added fat, they can serve as a healthy choice. Additionally, baked potatoes can be a blank canvas for other nutritious toppings, such as broccoli, black beans, salsa and avocado.

Peas
Peas are categorized as a starchy vegetable, which some people may equate to a bad choice nutritionally. For those managing their blood glucose levels, consuming starchy vegetables requires some balancing and moderation of total carbohydrate intake from their meals and snacks. However, not only does a half-cup serving of peas provide 4 grams of fiber, but it also packs 4 grams of protein, in addition to a wealth of vitamins and minerals — all for under 60 calories.

Frequently sold frozen, peas are a convenient add-in to soups, stir-fries and other mixed dishes. Easy-to-incorporate veggies such as peas can make a difference between getting in a serving versus skipping them.

Iceberg lettuce
While iceberg lettuce isn’t as nutritionally dense as other leafy greens, it does have redeeming qualities. Lettuce is high in water content and provides a crunchy texture for meals. Iceberg lettuce also provides folate, potassium and calcium.

In addition, iceberg lettuce is a low-calorie choice at just 10 calories per cup. Adding iceberg to a meal can help displace more calorie-dense food while still allowing for a full plate of food.

Corn
When we think of corn, we might think of corn syrup or the particularly villainous high fructose corn syrup. Fresh or frozen corn is quite different nutritionally from the highly refined syrup. Corn provides fiber, B vitamins, lutein and an abundance of antioxidants.

Consider adding corn to salads, soups and salsas, or enjoy it on the cob. The added fiber can help you feel full and improve your digestive health.
When it comes to vegetables, DeWolf says to keep the big picture in mind. While kale may be more nutritionally dense than iceberg lettuce, either would be a fantastic choice when compared to chips, soda or any processed snack.

“The key consideration is to ensure we are getting those veggies in each day,” she says.

3 things to know about high blood pressure and pregnancy
Feb. 15, 2022
Pregnant woman blood pressure
High blood pressure — also called hypertension — in pregnancy may not be a common condition, but it can be a concerning one.

Women are considered to have chronic hypertension in pregnancy if they had a preexisting hypertensive condition before getting pregnant or developed high blood pressure within the first 20 weeks of pregnancy. This type of hypertension should not be confused with gestational hypertension, which is high blood pressure identified after 20 weeks of pregnancy paired with normal blood pressure before pregnancy.

For women with chronic hypertension who are pregnant or planning to become pregnant, there are a few things to know.

Know the risks
While many women with chronic hypertension do well in pregnancy, it is important to know the risks associated with the condition. New research shows mortality rates have increased for pregnant women with chronic hypertension, especially among Black women. Obesity and advanced age contribute to even greater risk of hypertension-related maternal deaths.

Women who are pregnant and have chronic hypertension are also at increased risk for possible pregnancy complications, including:

Eclampsia
Superimposed preeclampsia
Fetal growth restriction
Placental abruption
Preterm birth
Cesarean section
Miscarriage
Fetal demise
Stroke
Maternal death
“It's important for women to know the risks of chronic hypertension to help prepare for additional surveillance before and after pregnancy, as well as to modify lifestyle choices prior to conception,” says Dr. Sara Junya, a board-certified obstetrician-gynecologist with Sharp Rees-Stealy Medical Group.

Work closely with designated doctors
As with any pregnancy, it’s important to adhere to regular prenatal care checkups. For pregnant women with chronic hypertension, more frequent prenatal visits are recommended.

It’s also not uncommon for women with chronic hypertension to consult with various doctors. At some point during the pregnancy, for example, a referral to a cardiologist might be necessary.

Dr. David Hall, a board-certified internal medicine doctor with Sharp Rees-Stealy Medical Group, advises that women on antihypertensive drugs should work closely with their primary care doctor and obstetrician to switch to drugs with an established fetal safety profile.

“Do not be afraid to ask questions of your doctor,” adds Dr. Junya. “No question is silly or too small. I often recommend writing down any questions and bringing them to your visit to ensure that we do not miss a topic you would like to discuss.”

Working closely with doctors includes maintaining care into the postpartum period. “We will work closely with you to make sure that the blood pressure fluctuations after delivery are not too low or too high, which can often require longer monitoring in the hospital postpartum or frequent postpartum visits to check blood pressure values,” Dr. Junya says.

Focus on factors within your control
Even though having chronic hypertension may seem overwhelming on top of managing pregnancy, there are strategies women can concentrate on to feel more in control. Dr. Hall recommends increasing one’s attention to lifestyle changes, such as sustaining a healthy diet, reducing sodium intake, and getting regular exercise and sleep. And Dr. Junya emphasizes the critical importance of stress reduction, as well as quitting use of tobacco, drugs and alcohol.

Additionally, following doctors’ instructions to check blood pressure at home and report any elevated values or signs or symptoms of increasing blood pressure is one action patients can focus on, Dr. Junya says. Another is being diligent in taking prescribed or over-the-counter medications as recommended by your doctors.

Experts agree that while experiencing chronic hypertension during pregnancy is not without its risks, having an attentive care team and following good health habits will help ensure a successful pregnancy.

High blood pressure’s connection to COVID-19
Feb. 2, 2022
Blood pressure monitor
When cases of COVID-19 began to surge around the world, experts realized the virus was particularly dangerous for people with heart disease and related conditions, especially high blood pressure. Nearly half of all adults in the U.S. — 103 million people — have high blood pressure, also known as hypertension.

More concerning is that only 1 in 4 adults have their blood pressure under control. Blood pressure that’s not well-managed can lead to serious complications, such as heart attack and stroke. As COVID-19 outbreaks continued, a new concern emerged. People with high blood pressure may be at greater risk of more serious complications from the coronavirus, including death.

Possible link between blood pressure regulation and COVID-19
“Early reports from areas of the world most affected by COVID-19 showed higher morbidity and mortality rates in patients with conditions like hypertension, coronary artery disease, diabetes and obesity,” says Dr. Steven Rough, a cardiologist affiliated with Sharp Chula Vista Medical Center. “What was found is COVID infects the cells that help regulate blood pressure, suggesting a possible link between hypertension and severe COVID infection. More studies are needed to determine if there is, in fact, a cause and effect.”

While the link between hypertension and serious complications isn’t entirely clear yet, what is clear is keeping blood pressure under control is extremely important.

COVID-19’s other dangerous implication is that it has kept many patients away from local hospitals and emergency rooms due to fears about getting the coronavirus. Hospitals across the country are reporting fewer visits for urgent medical needs, which some experts believe isn’t because patients are having fewer of them, but rather they’re avoiding or delaying seeking treatment.

In San Diego County, there have been 20 to 40 fewer heart attacks reported each month since the COVID-19 pandemic began, as well as a 70% decrease in calls to the Emergency Medical Services (EMS) system. With high blood pressure being a risk factor for serious conditions like heart attack, stroke and heart failure, it’s important that patients do all they can to keep it under control despite the pandemic.

Blood pressure measurement includes two numbers: systolic (top number) and diastolic (bottom number). People with a systolic above 130 or a diastolic above 80 — a reading of higher than 130/80 mmHg — are considered to have hypertension. Extreme high blood pressure, a reading of 180/120 mmHg or higher, should seek immediate medical attention. Anyone with a reading of 180/120 mmHg or higher who is also experiencing chest pain, shortness of breath, or changes in vision or speech should call 911.

“Having high blood pressure can lead to serious complications like heart attack, stroke, heart failure and aneurysm formation,” says Dr. Rough. “There is a lot that can be done for prevention, though. The best thing I can tell my patients with high blood pressure to do throughout this pandemic is to eat as healthy as possible, make time for exercise, stay current with appointments with your doctor, and don’t ever delay going to the emergency room for a serious medical need. We’ve already taken a lot of steps, and continue, to make the ER and hospital safe for patients to come in.”

To learn more about the extra safety precautions in place at Sharp Chula Vista Medical Center, visit sharp.com/getcare.

How does COVID-19 affect your eyes?
Feb. 7, 2022
Woman wearing mask rubbing her eyes
They may be baby blue, beautiful brown or groovy green. Whatever their color, the eyes are the second most complex organ after the brain and are made up of more than 2 million working parts. In fact, you only see one-sixth of the eyes when looking in the mirror.

We rely on our eyes thousands of times a day. Unfortunately, among the many challenges related to COVID-19, some people’s eye health has been negatively affected during the pandemic.

Pandemic-related eye problems
According to Dr. Gayle Howard, a board-certified ophthalmologist affiliated with Sharp Community Medical Group and Sharp Chula Vista Medical Center, even the use of face masks has caused some eye troubles. In the past two years, she reports there has been an increase in dry eye diagnoses.

“Wearing a mask forces the airflow upward, out of the mask, causing dry eye,” Dr. Howard says. “And the positioning of the face masks on the lower lid may cause it to be pulled downward, causing greater exposure and worsened dry eye.”

But don’t ditch those masks. With a few adjustments for a snug fit, you can remove any gaps that allow air to leak out of your mask. This will help you avoid dry eye, and ensure you continue to use this effective method to protect you from getting COVID-19, which can lead to a variety of eye conditions.

These include:

Decreased tear production due to inflammation in the lacrimal gland — the gland above the eye that produces tears
Sensitivity to light
Conjunctivitis, also known as pink eye
“There have been rare reports of episcleritis and iritis — more serious inflammation of the front parts of the eye,” Dr. Howard adds. “These conditions require immediate medical intervention.”

The American Academy of Ophthalmology also advises that after having COVID-19, some people will develop eye conditions ranging from mild to vision-threatening. These include:

“Cotton wool” spots — Blood clots prevent nutrients from reaching the retina, and the tissue in the retina begins to swell and die.
“Eye stroke” or retinal artery occlusion — Blood clots in the arteries of the retina block the flow of oxygen, causing cells to die, sometimes causing sudden, painless vision loss.
Retinal vein occlusion — A vein in the retina becomes blocked, raising blood pressure levels inside the eye, which can cause bleeding, swelling and fluid leaks, and lead to vision changes from blurry vision to sudden, permanent blindness.
Retinal hemorrhage — Blood vessels in the retina start bleeding, sometimes due to retinal vein occlusion, and can lead to blind spots and gradual or sudden loss of vision.
Dr. Howard encourages everyone to make an effort to maintain their eye health. Have a vision exam every year. And seek care from an ophthalmologist if you had COVID-19 and notice changes to your eye health or vision; have eye pain or dryness; get an eye infection; or are experiencing pressure in your eyes.

High blood pressure’s connection to COVID-19
Feb. 2, 2022
Blood pressure monitor
When cases of COVID-19 began to surge around the world, experts realized the virus was particularly dangerous for people with heart disease and related conditions, especially high blood pressure. Nearly half of all adults in the U.S. — 103 million people — have high blood pressure, also known as hypertension.

More concerning is that only 1 in 4 adults have their blood pressure under control. Blood pressure that’s not well-managed can lead to serious complications, such as heart attack and stroke. As COVID-19 outbreaks continued, a new concern emerged. People with high blood pressure may be at greater risk of more serious complications from the coronavirus, including death.

Possible link between blood pressure regulation and COVID-19
“Early reports from areas of the world most affected by COVID-19 showed higher morbidity and mortality rates in patients with conditions like hypertension, coronary artery disease, diabetes and obesity,” says Dr. Steven Rough, a cardiologist affiliated with Sharp Chula Vista Medical Center. “What was found is COVID infects the cells that help regulate blood pressure, suggesting a possible link between hypertension and severe COVID infection. More studies are needed to determine if there is, in fact, a cause and effect.”

While the link between hypertension and serious complications isn’t entirely clear yet, what is clear is keeping blood pressure under control is extremely important.

COVID-19’s other dangerous implication is that it has kept many patients away from local hospitals and emergency rooms due to fears about getting the coronavirus. Hospitals across the country are reporting fewer visits for urgent medical needs, which some experts believe isn’t because patients are having fewer of them, but rather they’re avoiding or delaying seeking treatment.

In San Diego County, there have been 20 to 40 fewer heart attacks reported each month since the COVID-19 pandemic began, as well as a 70% decrease in calls to the Emergency Medical Services (EMS) system. With high blood pressure being a risk factor for serious conditions like heart attack, stroke and heart failure, it’s important that patients do all they can to keep it under control despite the pandemic.

Blood pressure measurement includes two numbers: systolic (top number) and diastolic (bottom number). People with a systolic above 130 or a diastolic above 80 — a reading of higher than 130/80 mmHg — are considered to have hypertension. Extreme high blood pressure, a reading of 180/120 mmHg or higher, should seek immediate medical attention. Anyone with a reading of 180/120 mmHg or higher who is also experiencing chest pain, shortness of breath, or changes in vision or speech should call 911.

“Having high blood pressure can lead to serious complications like heart attack, stroke, heart failure and aneurysm formation,” says Dr. Rough. “There is a lot that can be done for prevention, though. The best thing I can tell my patients with high blood pressure to do throughout this pandemic is to eat as healthy as possible, make time for exercise, stay current with appointments with your doctor, and don’t ever delay going to the emergency room for a serious medical need. We’ve already taken a lot of steps, and continue, to make the ER and hospital safe for patients to come in.”

To learn more about the extra safety precautions in place at Sharp Chula Vista Medical Center, visit sharp.com/getcare.

Can you get COVID more than once?
Feb. 2, 2022
Woman wearing mask feeling ill
When attempting to explain the basic difference between the two recent variants of the coronavirus that causes COVID-19, you could say that delta is more dangerous, but omicron is everywhere. However, that doesn’t tell the whole story.

Early reports indicate that omicron may cause less severe illness. However, because it is far more contagious than previous variants, it has led to a surge in cases, an increase in hospitalizations, and a higher risk for COVID-19 reinfection — when someone is infected, recovers and then later becomes infected again.

Ask anyone who has had COVID-19 and they’ll tell you that once is bad enough — even severe or life-threatening for some. Getting it two or three times is certainly not appealing. But a repeat infection is possible, especially if you’ve not yet received a COVID-19 vaccine and booster.

Omicron presents increased risk
According to a recent U.K. study, the risk of COVID-19 reinfection is now 16 times greater than when delta was causing most COVID-19 cases. Also, the study revealed a few other significant findings related to omicron:

People who received a COVID-19 vaccine were less likely to be reinfected than those who were not vaccinated.
People who were unvaccinated were twice as likely to be reinfected than people who had their second vaccine within the last 3 months.
People who previously had COVID-19 were less likely to be reinfected than people not previously infected; however, their risk of reinfection with the omicron variant was greater than their risk of reinfection with delta.
“Essentially, the stakes are higher when it comes to omicron,” says Dr. Abisola Olulade, a family medicine doctor with Sharp Rees-Stealy Medical Group. “You’re risking a variety of things that can cause problems and may be debilitating for a lot of people, including long-term COVID.”

People who are unvaccinated at greater risk
The County of San Diego continues to report that the majority of people hospitalized for COVID-19-related complications are unvaccinated. In fact, the hospitalization rate in the county is 2 times higher for those not fully vaccinated. And the death rate for those who are not fully vaccinated is 7 times higher than fully vaccinated San Diegans.

“All of this definitively tells us that the best way to get protected is by vaccination,” says Dr. Olulade. “Vaccination is always going to be the safest way to get protected from this virus.”

The Centers for Disease Control and Prevention (CDC) recommends that everyone age 5 and older receive a COVID-19 vaccine. Those age 12 and older are also eligible and encouraged to receive a vaccine booster.

Experts also advise everyone to continue to follow other preventive measures:

Wear a well-fitting face mask in public locations
Stay 6 feet apart from people not in your household
Avoid crowds, people who are sick and poorly ventilated indoor spaces
Wash hands often with soap and water or use hand sanitizer with at least 60% alcohol
People should also get tested for COVID-19 if they have symptoms, have been in close contact with someone who has COVID-19, or are directed to be tested by their doctor, school, workplace or public health department.

Testing is available through several community and health care partners. At-home tests are also available online or in stores. Follow CDC quarantine and isolation guidelines while waiting for — and after receiving — test results.

Does the COVID-19 vaccine affect your period?
Jan. 27, 2022
Woman holding heat pack on abdomen
There are well-documented common side effects of the COVID-19 vaccines — arm soreness, headache, fever and fatigue. What’s more, some women have also reported experiencing changes in their menstrual cycle after COVID-19 vaccination.

“In our clinical practice, we have seen patients with complaints of irregular and heavier menses after receiving the COVID-19 vaccine,” says Dr. Ray Kamali, a board-certified OBGYN affiliated with Sharp Chula Vista Medical Center. “This was echoed by anecdotal reports from individuals on social media and various blogs.”

However, a recent study funded by the National Institutes of Health (NIH) indicates that the changes, if connected, are minimal.

Changes remain within normal range
According to researchers, those who received a dose of a COVID-19 vaccine did have an increase in cycle length — of just one day — when compared to unvaccinated women. The experts noted that menstrual cycles regularly vary month to month, and the slight deviation of one day was within a normal range of change.

“It is important to clarify that while the study findings did show an increase in cycle length — which refers to the time between one menstrual cycle to the next — the authors did not find any changes in menstrual duration, which is the number of days of bleeding,” Dr. Kamali says.

The study authors noted that additional research is needed to determine how COVID-19 vaccination might influence other menstrual characteristics, including symptoms such as water retention, mood changes and cramps, as well as the heaviness of blood flow during menstruation.

Causes other than vaccination
According to Dr. Kamali, however, some of the menstrual abnormalities reported in the last two years likely have more to do with the lifestyle changes brought about by the pandemic and less to do with the COVID-19 vaccines.

“Some of these changes can been attributed to the social, psychological and financial stress associated with the pandemic,” he says. “This includes changes in lifestyle from a more active to a more sedentary routine and subsequent weight gain.”

Additionally, Dr. Kamali points out that the reproductive system is closely linked to other internal systems, including the immune system. It is possible that the immune response created by the vaccine can cause a short-lived change to one’s periods. “We are not exactly sure why these changes occur,” he says.

No effect on fertility
And just as the vaccines have been shown to minimally affect menstrual cycles, there is currently no evidence that COVID-19 vaccination causes infertility. This is supported by another recent NIH study that did not find any difference in pregnancy success rates from women who had natural antibodies from COVID-19 infection, antibodies from vaccination, or no antibodies at all.

“In our region in Southern San Diego, vaccination rates are over 70% in reproductive-age women,” says Dr. Kamali. “And we certainly have not seen a decrease in new pregnancies.”

While Dr. Kamali stresses he understands that the decision to receive the vaccine can be a complex one for some patients, especially those who are pregnant or are planning to conceive, he encourages them to list their concerns and have an honest conversation with their doctor.

“This conversation must include the risks associated with COVID-19 infection,” he says. “Based on the available data, due to the risks of COVID-19 infection during pregnancy to mother and fetus, vaccination is recommended to those who are pregnant, breastfeeding and planning on becoming pregnant.”

Can omicron cause long COVID-19?
Jan. 25, 2022
Woman sick in bed
By mid-January, close to 99% of all new COVID-19 cases in the U.S. were due to the omicron variant. Since then, case numbers have continued to soar and hospitals across the country now find themselves overwhelmed by people with COVID-19 seeking care.

Early reports have indicated that the omicron variant is different than other variants of the coronavirus. It was labeled a variant of concern by the World Health Organization (WHO) because of the number of mutations within it — 22 more than the delta variant. And while omicron spreads like no other previous variant, it is believed that it may lead to milder illness.

However, questions about the symptoms of COVID-19 caused by omicron remain: Are the symptoms different, or just milder? Can the symptoms last after the infection and even be long-term — known as long-haul COVID-19 or long COVID?

According to Dr. Kaveh Bahmanpour, a board-certified family medicine and geriatric medicine doctor affiliated with Sharp Community Medical Group, some of the answers to these questions about omicron have been revealed and some are still unknown.

“It has become apparent that omicron generally leads to milder symptoms for the most part,” Dr. Bahmanpour says. “And symptoms usually last 5 to 10 days, which is shorter than previous variants, which could last up to 14 days.”

The Centers for Disease Control and Prevention (CDC) does not differentiate between the symptoms caused by each variant. Common symptoms of COVID-19 — regardless of which variant may have caused the infection — include the following, with the symptoms in bold being the most reported now:

Cough
Congestion or runny nose
Fatigue
Headache
Sore throat
Muscle or body aches
Shortness of breath or difficulty breathing
New loss of taste or smell
Fever or chills
Nausea or vomiting
Diarrhea
The possibility of long COVID
While omicron may cause less severe symptoms, this may not mean a decreased risk of long-term sickness. In fact, the CDC advises that long COVID — a range of symptoms that can last weeks or months after a person is first infected, or can appear weeks after infection — can happen to anyone who has had COVID-19, even if their illness was mild or they didn’t have any symptoms (asymptomatic).

Experts estimate up to 30% of people who have experienced COVID-19 are likely to have persistent symptoms. These symptoms can include those commonly experienced with COVID-19, along with:

Brain fog
Chest or stomach pain
Lightheadedness
Fast-beating or pounding heart (heart palpitations)
Sleep problems
Change in smell or taste
Sensation of pins and needles
Rash
Mood changes
Also, a small number of children with COVID-19 — or who had COVID-19 — experience multisystem inflammatory syndrome (MIS-C). MIS-C is a rare, life-threatening condition that can cause dangerous inflammation in the eyes, skin, blood vessels and heart.

“The possibility of long-term symptoms was something that we found out later in the course of the disease,” Dr. Bahmanpour says. “As we collect more data about each variant, we will be able to predict more. For now, while omicron seems to cause milder symptoms, the possibility of long-term effects is something yet to be determined.”

Decrease your risk
Hospitals across San Diego County are experiencing a surge of patients with severe COVID-19 due to the increased contagiousness of omicron, indicating that not all omicron-related cases are mild. In California alone, the average daily number of patients hospitalized with COVID-19 in the first two weeks of the year was over 11,000.

What’s more, unvaccinated people in the state were found to be eight times more likely to be hospitalized with COVID-19 than fully vaccinated people. This is why vaccination — and receiving a booster shot when eligible — remains vital to stop the spread of COVID-19 and reduce the risk of severe illness, hospitalization and death.

If you experience a coronavirus infection, regardless of your vaccination status, Dr. Bahmanpour advises following the CDC guidance to isolate for no less than 5 days from when symptoms started or testing positive. Isolation can end only if you are fever-free for 24 hours without the use of fever-reducing medication and any other symptoms are improving. You should then wear a face mask around others — in your home and in public — for 5 more days.

“Most of the symptoms should improve after 10 days,” he says. “However, if you are still feeling fatigue and headache or persistent cough, you should be seen by a doctor. Additionally, if you experience shortness of breath anytime during the course of the disease, you need to seek immediate care.”

COVID-19 antiviral drugs arrive as surge strikes
Jan. 20, 2022
Pharmacist explaining medication to patient
As the omicron variant began to rapidly spread across the country in late 2021, two new treatments for those at greatest risk of serious illness from COVID-19 were given emergency use authorization (EUA) by the Food and Drug Administration (FDA). Drugmakers Pfizer and Merck’s prescription oral antiviral medications were added to the toolbox of treatments for mild to moderate COVID-19.

“The two new treatments give physicians another tool to fight COVID,” says Suzanne Shea, RPh, vice president of Sharp HealthCare’s system pharmacy services. “Pfizer’s Paxlovid and Merck’s molnupiravir are both authorized for COVID-positive patients who are at high risk for severe illness.”

However, Shea is quick to point out that the medications are not prophylactic treatments, meaning they are not intended to prevent disease. But because both are oral medications in tablet form, a trip to an infusion center is not needed. “This saves time for our clinicians, and patients can be treated at home,” Shea says.

How COVID-19 antiviral medications work
The two new COVID-19 antiviral medications prevent the coronavirus from replicating, allowing people with COVID-19 who may be at risk for developing severe illness to avoid hospitalization. And with hospitals throughout the U.S. overwhelmed by increasing numbers of patients needing care for COVID-19, the medications are arriving at the perfect time.

While Shea reports that there are differences in the drugs’ effectiveness — studies have found Paxlovid 89% effective and molnupiravir 30% effective in treating COVID-19 — both are showing the ability to be effective against the delta and omicron variants when taken as directed. The prescription oral antivirals are to be started as soon as possible after a diagnosis of COVID-19 and within 5 days of symptom onset.

Eligibility for treatment with the new antiviral drugs
According to the drugs’ EUAs, Pfizer’s Paxlovid can be used in patients age 12 and older with confirmed COVID-19. Due to its possible effect on bone and cartilage growth, the Merck drug molnupiravir is limited to COVID-positive patients age 18 and older.

Additionally, the Merck drug is not for use with pregnant women, and the Pfizer drug should not be taken by people with kidney or liver disease. Pfizer’s Paxlovid may also cause interactions with commonly prescribed drugs, such as blood thinners, statins, HIV treatments and antidepressants. Talk with your doctor about whether Paxlovid is right for you.

Vaccination remains vital
While the addition of the two new antiviral medications to treat COVID-19 is to be celebrated, experts agree that vaccination is the best way to lower the risk of getting and spreading COVID-19. Vaccines are also safe and highly effective at preventing serious illness and death.

What’s more, doctors are reporting difficulty in accessing supplies of the new antiviral medications for their patients. So, availability of the drugs cannot be counted on as a substitute for vaccination.

On the other hand, access to COVID-19 vaccines is abundant in most areas of the country. Children age 5 and older can receive the Pfizer COVID-19 vaccine, and adults age 18 and older can receive either the Pfizer or Moderna COVID-19 vaccines. Additionally, the Centers for Disease Control and Prevention (CDC) now recommends that all adults and adolescents age 12 and older receive a booster shot.

“Our first line of prevention of COVID-19 is still the vaccine and now, getting a booster,” Shea says. “These are shown to prevent COVID-19 and if infected, patients are far less likely to be hospitalized and suffer a severe form of the disease. Most hospitalized patients are not vaccinated, and so we can’t emphasize enough the importance of receiving a COVID-19 vaccine and booster when eligible.”

Which mask should you wear?
Jan. 18, 2022
Woman wearing mask
Most COVID-conscious people have a basket, drawer or hook overflowing with face masks. They might be fabric, surgical or specialty. And depending on what material they’re made of, some might be less effective than others.

According to recent guidelines from the Centers for Disease Control and Prevention (CDC), it is important that people wear the most effective mask they can get to protect themselves from the rapidly spreading and highly contagious omicron variant, as well as the still circulating delta variant, which may cause more severe disease.

Here’s what you need to know now about face masks:

Mask-up when warranted. While face masks are no longer mandated for people who are vaccinated in California – with the exception of schools, health care settings, and a couple of other locales — all people who have not yet received a COVID-19 vaccine must continue to wear a face mask in public locations. Additionally, everyone age 2 or older — regardless of vaccination status — may want to consider wearing a mask in crowded indoor public places, when sick and when around people who are or might be sick.

Snug is safest. Face masks should completely cover the nose and mouth and fit snugly against the sides of the face. While comfort is important in ensuring you’ll continue to wear the mask as needed, a snug fit will help keep you better protected during an exposure. However, avoid making the mask so snug that it is difficult to breathe. If you have a beard, consider adding a mask fitter or brace, or double mask for added protection.

Mind the gap. Face mask coverage should be without gaps, and masks should have a nose wire to prevent air — and germy aerosols and particles — from leaking in or out. Do a gap check: Put on your face mask and exhale heavily — if you can feel your breath’s breeze on your nose, cheeks, chin or neck, your mask likely needs to be adjusted.

N is for NIOSH-approved. Studies have shown that authentic National Institute for Occupational Safety and Health (NIOSH)-approved N95 masks, also known as respirators, and authentic KN95 masks do the best to protect people from the highly transmissible omicron variant — capturing and filtering 95% of airborne particles as small as 0.3 microns. NIOSH-approved N95 masks pass rigorous inspection and certification processes in the U.S., and authentic KN95 masks must meet Chinese standards for effectiveness and are approved by the Food and Drug Administration (FDA) for sale in the U.S.

The rest are second best (but not bad). While well-fitting surgical-style masks or cloth masks — in that order — are better than no mask at all, consider them your second choice if you can get authentic N95 or KN95 masks. But buyer beware: The CDC estimates that approximately 60% of the N95 and KN95 masks currently being sold in the U.S. are counterfeit. Without access to one of the more authentic protective masks, try snugly layering a cloth mask over a surgical mask to better catch droplets and aerosols.

While the CDC’s updated guidance does not state that you must wear an N95 or KN95, health officials strongly suggest you consider it. Most importantly, the guidelines state that to protect yourself and others from COVID-19, it is recommended that you “wear the most protective mask you can that fits well and that you will wear consistently.”

This story was updated in February 2022 to reflect updates to mask mandates.

Omicron and kids: what parents need to know
Jan. 14, 2022
Mother and son wearing masks
Most pediatricians have spent lots of time, energy and passion encouraging parents to allow their children age 5 and older to receive a COVID-19 vaccine. Their expertise, the data and their trust in science offer all they need to know that vaccination is safe, effective and vital in our efforts to stop the spread of the coronavirus and keep children — and those around them — healthy.

For Dr. Ahmad Bailony, department chief of pediatrics at Sharp Chula Vista Medical Center, his own experience as a child has afforded him a unique viewpoint when it comes to vaccine-preventable diseases: He almost died due to the complications of one.

“When I was a kid, I was hospitalized for weeks with meningitis,” he says. “In my entire career as a doctor, I’ve never seen a case of that specific type of meningitis among my patients, and that’s because we now have a vaccine for that disease.”

The contagiousness of omicron
Another thing Dr. Bailony says he’s yet to see in his 17 years as a pediatrician is a virus that is as contagious as the omicron variant of the coronavirus.

“It is no exaggeration that approximately every other call coming into our office is about COVID-19,” he says. “COVID, in general, and the rapid spread of omicron are really causing parents a lot of stress and anxiety, which is understandable.”

According to Dr. Bailony, anecdotal evidence is showing that omicron may cause less severe illness in people of all ages than previous variants. However, he says that more children are seeking care and requiring hospitalization now that omicron is spreading.

“Given that this variant is more contagious, an increased number of children are getting COVID-19, especially those under the age of 5 who are not yet eligible for vaccination,” he says. “So, as more children get COVID, you’ll inevitably see more kids becoming more severely ill from it.”

This is why, Dr. Bailony says, it is crucial that everyone who is eligible for COVID-19 vaccination — including children age 5 and older and their family members, and those age 12 and older eligible to receive a booster shot — get vaccinated so we can stop the spread and protect more children from becoming ill. “This is a matter of all of us taking care of each other — we’re in this together,” he says.

Dr. Bailony also recommends that families continue to practice all other COVID-prevention strategies:

Choose outdoor activities over indoor activities.
Wear a face mask when in indoor public locations.
Avoid places that are poorly ventilated.
Avoid crowded places and gatherings where it is difficult to stay 6 feet away from others.
Wash hands often with soap and water or use a hand sanitizer with at least 60% alcohol.
Avoid touching your eyes, nose and mouth.
Sanitize frequently touched surfaces.
Avoid people who are sick.
Monitor your health for symptoms of COVID-19 — cough, nasal congestion, fatigue, sore throat, headache, body aches and fever — and get tested if symptoms develop.
If your child has COVID
As COVID-19 cases rise within the community, your child’s chance of COVID exposure and infection also rises. However, Dr. Bailony stresses that in most cases, you can treat your child as you would if they had any other respiratory illness.

Symptoms are usually mild and last a few days to a week. Although, a very small number of children may experience multisystem inflammatory syndrome (MIS-C), a rare, life-threatening condition that can cause dangerous inflammation in the eyes, skin, blood vessels and heart.

“If your child is not having trouble breathing, is taking fluids pretty well and still making good urine output, generally, you can watch them at home,” he says. “You should definitely have them tested for COVID, which may take some patience as there is a great demand for testing. And then, you should isolate your child from others and contact your child’s pediatrician for further advice.”

The Centers for Disease Control and Prevention (CDC) also recommends talking to your child’s doctor about using pediatric over-the-counter medications for fever, aches and pain. And make sure your child rests and drinks a lot of fluids.

Also, you should monitor your child for signs of severe illness, and seek emergency medical care immediately if they are experiencing any:

Trouble breathing
Pain or pressure in the chest
Confusion
Inability to wake or stay awake
Pale, gray or blue-colored skin, lips or nail beds
“The best way to protect your child from illness is to get them vaccinated and boosted when they’re eligible,” Dr. Bailony says. “We have been vaccinating kids for months now, and 100% that have come through our office and received a vaccine have been fine. In fact, a lot of them are excited to get it, and their parents are relieved that we have vaccines to avoid severe pediatric illness and hospitalization like my own.”

My kid got COVID, but I didn’t — here’s why
Jan. 14, 2022
San Diego teenager Evie Spengler
After the effectiveness of her COVID-19 vaccine waned, 13-year-old Evie Spengler got infected, but her symptoms were mild.

Jennifer Spengler is a health and wellness writer for Sharp Health News.

I have written about how my daughter, a 13-year-old eighth grader, participated in the Pfizer COVID-19 vaccine trial for adolescents in 2020. I was incredibly proud of her for stepping up to help stop the spread of COVID when some adults refused to do so much as wear a face mask around others.

Unfortunately, it was her participation in that very trial that may have led to a recent breakthrough infection. And yet, we wouldn’t change a thing.

You see, most kids ages 12 to 15 could not roll up their sleeves for vaccination until May 2021, when the FDA granted the Pfizer COVID-19 vaccine emergency use authorization for this group. But my daughter received her first vaccine dose on Dec. 15, 2020 — several months earlier and even before the majority of U.S. health care workers received their first shot. By mid-January 2021, she was fully vaccinated.

So, when she was exposed to COVID-19 at school in early December 2021, nearly a year later, the effectiveness of her vaccination had likely waned. While we hoped her immunization would continue to prevent infection, even as word of the omicron variant — and the variant itself — began to spread, we soon learned our luck and her protection had worn out.

However, not for a second have we felt disappointed in the effectiveness of the vaccines or regretted her trial participation. On the contrary, the lessons we learned from her breakthrough infection gave us more reason than ever to believe that vaccination is vital. It is our hope that in sharing our experience, more people will feel the same.

Here are some of our takeaways:

The COVID-19 vaccines work. My daughter had been exposed to people with COVID-19 previously during the pandemic. Not once before did the exposure cause infection. It was not until approximately a year after she received the vaccine that the virus was able to break through. Research has found that protection against infection remains high for six months after the second shot of the Pfizer vaccine. So, her vaccination was effective nearly twice as long as expected. What’s more, studies now tell us that infection after vaccination may lead to “super immunity” to the coronavirus, which is super news to this parent.

Vaccinated people tend to experience mild or no symptoms. My daughter had a little congestion and a headache for a few days, starting about three days after her exposure. However, her discomfort was never great enough to make her want to stop binge-watching her favorite shows, put away the Lego set she was working on, or take a break from playing remote video games with her friends. Admittedly, she was a bit bored during her 10 days of isolation but rarely uncomfortable, and over-the-counter pain relievers, hydration and lots of TLC helped keep her that way.

The boosters worked for the rest of us. My husband, our adult daughter who came home from college for the holidays, and I all received vaccine booster shots. While we were careful around our infected one, we weren’t overly exacting about maintaining 6 feet at all times or keeping her restricted to just one room. We allowed her to sit in the family room — several feet away and masked — to watch a movie, and we set up a chair and TV tray about 8 feet away a few times so she could join our dinner conversations. And because I hated not being able to hug her while she was isolated, I occasionally gave her a quick squeeze from behind, which she thought was “totally weird” — she’s 13, after all — but felt “totally great” to me.

COVID-19 can be slow to show. One Monday in December, we received notification from our daughter’s school that she was considered a close contact to someone who tested positive for COVID-19 during that morning’s on-campus COVID screening. A student she spent over an hour with that same morning later confirmed it was their test that came back positive. Because of this exposure, my daughter was tested every day that week. It wasn’t until Friday night that an at-home antigen test displayed a positive result — all other test results had been negative until then. She did not test positive for more than four full days after the initial exposure and one full day after she began to experience symptoms. However, research tells us she could have been contagious to others up to two days before she started to experience symptoms or tested positive.

Even if mild, COVID-19 can be alarming. I work in health care, so I hear the latest data on COVID-19 case numbers (still shockingly high), read many of the studies, and know that even kids can become severely ill. While we were very lucky that she was vaccinated, we were vaccinated and boosted, and our daughter’s case was mild, I couldn’t help but worry about the many “what ifs” surrounding COVID. We were unable to learn which variant she was exposed to, so what if delta — thought to possibly cause more severe illness than omicron — had caused her infection and could have led to more serious complications? What if her breathing, heart or other organs were affected? What if she experienced long-term symptoms? All of these things are preventable with vaccination, so I can’t imagine going without, now that we have such safe and effective options.

While I obviously wish that my daughter had never been exposed to COVID-19 or had the illness, I am incredibly pleased that she is doing so well, and that we can share what we learned. We know how fortunate we are to have access to safe and effective vaccines, have a school that places importance on regularly testing students to prevent further spread, and that we had the space and know-how to keep the rest of the family safe throughout her contagiousness.

Our greatest takeaway from this experience is that our daughter is now healthy and well, and we have the vaccines — and her participation in the vaccine trials along with thousands of others — to thank for that. Hopefully, those who have yet to be vaccinated will join us in recognizing the value in receiving a COVID-19 vaccine to protect themselves, their loved ones and everyone in our community.

Which COVID-19 test is best?
Jan. 13, 2022
COVID-19 swab test
COVID-19 testing experiences across the country have been varied. While one person may receive test results within minutes, another can wait more than a week to know whether or not they have been infected. Some people choose to pay hundreds of dollars out of pocket at a pop-up testing site, while others are able to secure free at-home testing kits at their local library.

Regardless of the amount you might pay for a test or the time it takes to receive your results, Dr. Omid Bakhtar, a board-certified pathologist affiliated with Sharp HealthCare, says testing plays a vital role in helping to stop the spread of COVID-19.

Types of COVID-19 diagnostic tests
There are currently two primary types of approved COVID-19 tests used to determine the presence of viral infection in both vaccinated and unvaccinated people:

Nuclear acid amplification tests (NAAT) — a common example is a PCR test — detect the virus’s genetic material. The sample is taken with a nasal or throat swab, or from a person’s saliva. The tests are highly accurate, but results can take up to 1 week. In fact, these tests are so incredibly sensitive that in some scenarios they may detect “genetic” fragments of a prior or waning infection, meaning the person whose sample was tested and is deemed positive may be carrying a very low viral load and is less likely to be contagious.

Antigen tests — sometimes referred to as rapid tests — detect specific proteins on the surface of the virus. The sample is taken with a nasal or throat swab either at a testing facility or using an FDA-approved at-home test, and results can be produced within minutes in some cases. While positive results are usually accurate, negative results may need to be confirmed with a PCR test. These tests perform best when the person is tested in the early stages of COVID-19 infection, when viral load is highest.
“While antigen tests are faster, less expensive and don’t require the level of laboratory equipment that PCR tests do, they are specifically made to be used in people who have symptoms,” Dr. Bakhtar says. “They also have a higher likelihood of producing false-negative results.”

However, Dr. Bakhtar reports that antigen tests are highly accurate in determining positive results and are valuable when used to perform screening within large populations, such as school students or employees of large companies. This type of screening must be done repeatedly to quickly identify people with active COVID-19 infection and to accumulate data on the rate of infection within a population.

“Similarly, antigen tests can also be used in asymptomatic people who have had a COVID exposure,” he says. “In such scenarios, they are best used in a repeated fashion, such as performing two to three tests, two days apart.”

Another type of testing, antibody testing — also known as serology testing — screens for past infection or prior vaccination. The test determines the presence of antibodies — nucleocapsid antibodies from past infection or spike antibodies from prior vaccination — which are proteins that fight off infections and can often provide immunity against catching the same infection again.

However, most currently available antibody tests do not screen for active COVID-19 infection and cannot be used for diagnostic purposes. Moreover, the utility of antibody testing for vaccination status is not well established and is currently not recommended.

When to be tested and what to do with the result
The CDC recommends people should be tested for COVID-19 if they:

Have symptoms of COVID-19, regardless of vaccination status
Are unvaccinated and had close contact — were within 6 feet of an infected person for a total of 15 minutes or more — with someone who is confirmed to have COVID-19, regardless of whether experiencing symptoms or not
Are vaccinated and had close contact with someone who is confirmed to have COVID-19 and are experiencing symptoms
Have been asked or referred to get testing by their health care provider or the health department
Once tested, people should quarantine at home until they receive their test results.

If you test positive, you can assume you have COVID-19 and are contagious. You should follow all isolation and prevention guidance to protect others from getting sick.

In California, this includes staying home for at least 5 days. Your isolation can end after day 5 if you do not have symptoms and test negative on day 5 or later. However, you should continue to wear a well-fitting mask around others for a total of 10 days, especially in indoor settings.

In all other cases, the isolation guidance is:

If you are unable to test or choose not to test, and you do not have symptoms or your symptoms are resolving, your isolation can end after day 10.
If you have a fever, your isolation should be continued until your fever resolves without the use of fever-reducing medication.
If your symptoms other than fever are not resolving, you should continue to isolate until all symptoms are resolved or until after day 10.
If you test negative, it means that you probably did not have COVID-19 at the precise moment your sample was collected. However, it is important to remember the risk of false-negative results if a rapid antigen test was performed.

According to Dr. Bakhtar, a follow-up PCR test may be in order, especially if you have been exposed to COVID-19 or are experiencing symptoms. Until that test can be performed, you should continue to follow prevention guidance.

How to get tested
San Diego emergency rooms and urgent care centers are currently experiencing high volumes of patients. If you need a COVID-19 test, it is recommended you go to a designated testing location, rather than an ER or urgent care, unless you have significant COVID-19 symptoms and are at risk for serious illness.

Local health experts recommend the following testing resources:

If you have severe illness — or are at risk for severe illness — contact your health care provider.
If you need to be tested due to a confirmed exposure or you are experiencing symptoms and are under age 65 with no underlying health conditions, you can visit one of the options offered by San Diego community and health care partners. You can also purchase self-test kits at some local pharmacies or online. Some public health agencies and school districts are providing free at-home kits as supplies allow.
If you do not have COVID symptoms, have not had an exposure, or are under age 65 with no underlying health issues, but need to be tested for school, travel, work or for other purposes, visit a County of San Diego testing location or consult your school, employer or travel company for testing options.
“Knowing whether you have COVID-19 is a ‘here and now’ situation, as a test today can’t tell whether you might have it two, five or 10 days from now,” Dr. Bakhtar says. “Regardless of your vaccination status, if you are experiencing symptoms, you should get tested and could consider testing again five days later.”

Learn about COVID-19 screening and testing at Sharp.

Oh my, ‘flurona’!
Jan. 13, 2022
Woman sick on the couch
Whether you call it “flurona,” “double trouble,” a “twindemic” or a “surge upon a surge,” combining the flu and COVID-19 sounds like a miserable proposition. Unfortunately, it is possible.

According to the Centers for Disease Control and Prevention (CDC), the flu and COVID-19 are caused by different viruses, but there are several similarities between the two. They share common symptoms, affect the respiratory system, are contagious, and can cause mild to severe illness.

Medical experts around the globe are concerned about the likelihood of an overwhelming number of cases of both illnesses. And in some cases, being infected by both viruses at the same time may occur. Not only are many people at high risk for severe illness caused by flu and COVID-19 — separately or together — but some hospitals might not have the resources to care for the increased number of severely ill patients.

“We’re anticipating a higher than normal flu season this year along with an underlying pandemic,” says Dr. Jyotu Sandhu, a family medicine doctor with Sharp Rees-Stealy Medical Group. “Normally, about 50% of the population receive a flu shot, leaving an additional 50% who don’t get vaccinated, along with a whole population that was not exposed to last year’s strains due to COVID mitigation efforts. Now, you’ve got a tidal wave of flu waiting to come in just as the COVID-19 omicron variant is increasing our case numbers.”

Additionally, according to Dr. Sandhu, contracting both viruses at the same time could be serious. “They’re both respiratory infections, they both can cause severe illness, even death, and when contracted together, they can have dangerous outcomes,” he says.

Vaccines can help prevent both illnesses
The good news is that there are safe and effective vaccines for both the flu and COVID-19 that can prevent severe illness, hospitalizations and deaths. This offers a solution for lightening the load of illness in each region if everyone who can get vaccinated does so.

In fact, the CDC reports that the flu vaccine has been shown to reduce the risk of having to go to the doctor with the flu by 40% to 60%. Flu vaccination among adults was also associated with a 26% lower risk of ICU admission and a 31% lower risk of death from flu compared to people who were unvaccinated.

What’s more, the COVID-19 vaccines are extremely safe and effective. While the omicron variant has led to some mild breakthrough cases among vaccinated people, the vaccines, when paired with a booster shot, remain highly effective at preventing severe illness, hospitalization or worse.

“It is so important to share the message that vaccination can protect you from severe illness and help local health care systems avoid being overwhelmed,” Dr. Sandhu says. “And it is vital that you get a COVID-19 vaccine, a COVID vaccine booster, and a flu vaccine to avoid what they’re calling ‘flurona.’”

The CDC says: Get the shots
But what if you’ve already had COVID-19? Do you still need to get a COVID-19 vaccine or flu shot? If so, is it safe to get either vaccine while sick with or shortly after recovering from COVID-19?

Because different viruses cause the flu and COVID-19, having recovered from COVID-19 does not make you immune to the flu. But the annual flu vaccine offers protection against the flu strains thought to be the most common during this year’s flu season.

Having COVID-19 may provide you with some immunity to having that disease again in the future, but it is unknown how long your natural immunity will last. And immunity gained through infection varies from person to person.

The CDC recommends receiving both vaccines, including a COVID-19 vaccine booster when eligible, even after having COVID-19, with the following in mind:

If you currently have COVID-19, both your flu and COVID-19 vaccination should be postponed for no less than 10 days from your positive test result; at least 10 days after your symptoms first began; and only if you have no fever without the use of fever-reducing medicines for 24 hours.
Even if you have no or very mild symptoms, you should postpone getting your vaccinations to avoid exposing others — including your health care provider and other patients — to the virus that causes COVID-19.
If you had a known exposure to a person with COVID-19, you should also wait to receive your vaccinations until your quarantine period has ended.
After that, the CDC reports that it is safe to receive both your flu and COVID-19 vaccine (or COVID-19 vaccine booster) and you can even receive them at the same time. It’s also important to note that the flu vaccine cannot give you the flu and the COVID-19 vaccines cannot give you COVID-19. Additionally, neither the flu vaccine nor the COVID-19 vaccines makes you more vulnerable to the other illness.

“Hospitals across the country are already showing signs that they can’t handle the sheer numbers of seriously ill patients, so we’re advising people to stay safe and prevent both flu and COVID-19 infection through vaccination before they become a greater problem,” Dr. Sandhu says. “They’re both very real, they’re both very active and they’re both happening concurrently. We have to take both seriously.”

Learn more about how to get flu shots and COVID-19 vaccines in San Diego.