More doctors are prescribing exercise instead of medication

Doctors treating chronic health problems are increasingly prescribing exercise for their patients and encourage them to think of physical activity as their new medication.

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When Dr Michelle Johnson scribbles out prescriptions, the next stop for many of her patients is the gym, not the pharmacy.

New medication

Doctors treating chronic health problems are increasingly prescribing exercise for their patients – and encouraging them to think of physical activity as their new medication.

In one such programme run by a health centre in Boston's Roxbury neighborhood, primary care physicians, internists and psychologists prescribe access to a gym for R160 a month, including free child care, classes and kids programmes.

Providing affordable gym access for patients ensures compliance, said Gibbs Saunders of Healthworks Community Fitness, a nonprofit gym in Dorchester that has partnered with several health care providers to help low-income residents fill their exercise prescriptions.

Read: Exercise can reduce your cancer risk by up to 40%

Executives at the Whittier Street Health Centre say low-cost access to a gym is important, since many residents' income is low and 70 percent of those they treat suffer from chronic problems such as obesity, high blood pressure, diabetes and depression.

Life expectancy in Roxbury is 59 years – well below the national average of 78.8 years.

"Exercise is not a new medicine, it's really an old medicine," said Johnson, who prescribes exercise to patients at the Roxbury-based health centre "But you know, I think we're now coming to the point of understanding how important it is."

Other, less visible benefits

Monisha Long, who is morbidly obese and suffers from hypertension, got a doctor's prescription for exercise and says she's had visible and dramatic results after more than two years of regular workouts.

Read: 20 good reasons to get moving

 "I lost well over 68kgs, and I've been keeping it off for the past couple of years," she said after working out on an elliptical machine at Healthworks.

And Long cites other, less-visible benefits.

"I'm more energised," she said. "As far as my energy, I feel like I'm stronger, I feel like I'm less tired, I feel like I can do almost anything now."

People who are physically active tend to live longer and are at lower risk of heart disease, stroke, type 2 diabetes, depression and some cancers, according to the U.S. Centres for Disease and Control and Prevention. Yet fewer than one in four American adults exercises enough to reap those benefits, the agency says.

Read: We need to exercise more AND spend less time sitting

Dr Edward Phillips, a Boston physician, is so sold on exercise he pedals on a stationary bike that's integrated into his office desk. Phillips said exercise is "like taking a little bit of Prozac – an antidepressant – and a little bit of Ritalin, which is a stimulant."

A bargain

"Our bodies are meant to move," he said. "Integrating movement into our day allows the system to work optimally. Part of the system that needs to work is our brain, and includes sleep, mood, cognition, ability to concentrate."

A prescription for exercise is a bargain, said Stephanie Dennis, who works out on a treadmill to stay fit.

"R160 a month is R32 a week," she said. "A lot of people pay that every day for coffee. It's not a big sacrifice for something that you get big rewards from." 

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Insulin treatment may increase breast cancer risk

Insulin treatment may increase breast cancer risk

Women with diabetes who take insulin have 'denser' breasts, which can increase their risk for breast cancer.

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Women with diabetes who take insulin appear to have a higher risk of dense breasts, a known risk factor for breast cancer, new research suggests.

No cause-and-effect relationship

Women with diabetes who take insulin "have considerably increased breast density [compared to] women without diabetes", said study lead researcher Zorana Andersen. She's an associate professor of epidemiology at the University of Southern Denmark in Esjberg.

Conversely, women taking the oral medicationmetformin instead of insulin to treat their diabetes seem less likely to have dense breasts, Andersen said.

Women with breasts that were more than 75 percent dense had a four to six times higher risk of breast cancer than women whose breasts were fattier, with a density of less than 25 percent, the researchers said.

Read: Type 1 diabetes linked to higher risk of some cancers

Andersen and her team emphasised that, while insulin treatment was linked with greater chances of higher breast density, that doesn't prove insulin increases breast cancer risk. The study wasn't designed to prove a cause-and-effect relationship.

Andersen was to present the findings at the European Breast Cancer Conference in Amsterdam, the Netherlands. Research from meetings is generally viewed as preliminary until published in a peer-reviewed journal.

For the study, Andersen evaluated more than 5,600 women. They all had mammograms between 1993 and 2001. The average age was 56. Most of the women were past menopause. More than half had breasts classified as mixed or dense. Slightly more than 2 percent of the women had diabetes.

Role of insulin still unclear

Overall, women with diabetes were less likely to have mixed or dense breasts, the study found.

Read: Diabetes and the heart

However, women taking insulin injections were more than twice as likely to have dense or mixed (dense and fatty) breasts, the study found. This was true regardless of their body mass index, or whether they had gone through menopause – when breasts may become less dense, the researchers said.

Meanwhile, women with diabetes who managed their condition with diet or with non-insulin medications were less likely to have dense breasts, the study found.

Diabetes has previously been linked with a higher risk of breast cancer, Andersen said. But, exactly why there has been an association hasn't been clear. It's also not clear how insulin may be increasing the odds of denser breasts.

Cancer cells grow rapidly and uncontrollably, and growth factors are crucial for cancer to progress, Andersen said. "Insulin is a growth promoting factor of all body tissues," she said, "and thus it is plausible that it can increase the amount of epithelial or stromal tissue in the breast, thus increasing overall breast density."

Read: New medical procedure offers hope for diabetes patients with gastroparesis

For now, Andersen said, women should be aware that different types of diabetes treatments seem to affect breast density differently. Women on insulin should consider asking their doctor about whether they need extra screening with mammograms and other tests, she added.

Andersen wants to look further at the effect of different diabetes treatments on breast cancer risk, including the finding that the non-insulin medications were linked with less breast density.

Dr Wei Feng is an endocrinologist at the City of Hope Cancer Centre in Duarte, California. She called the study finding interesting and novel. She also said she'd like to see more research on the link between non-insulin medication, such as metformin, and reduced breast density. 

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Could you have diabetes without realising it?

Could you have diabetes without realising it?

3.6 million South Africans have diabetes and many more are living with diabetes but aren't aware of it because they aren't experiencing symptoms. Know what's putting you at risk and why you should get screened.

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While you may feel fine now, the scary truth is that you could be at risk of developingdiabetes in future or worse, living with it right now without knowing!

The cost of diabetes

The estimated global cost to treat and prevent diabetes and its complications are expected to total at least US Dollar (USD) 376 billion this year. By the year 2030, this number is anticipated to exceed some USD490 billion. 

There are 3.6 million South Africansdiagnosed with diabetes but sadly, there are many more who are undiagnosed and untreated.

The Independent Community Pharmacy Association (ICPA) recently screened 10 000 South Africans for diabetes and found that one in three of the participants tested have a high risk for developing diabetes over the next 10 years. 

Most sobering of all, perhaps, is that the number of people living with diabetes is set to outstrip those living with HIV/Aids in 20 years’ time should there be no intervention.

The majority of South Africans with diabetes have type 2 diabetes. Because type 2 diabetes doesn’t always cause obvious symptoms, many of us live for years with diabetes without realising it.

In fact, it is estimated that most diabetics have been living with the condition for seven years before they are diagnosed.

Unfortunately, this means that their blood glucose levels haven’t been controlled for all that time and as a result, as many as 30% of those that are newly-diagnosed are already experiencing serious diabetes-related complications such as nerve damage, circulatory issues, blindness and organ damage.

Read: 12 facts you should know about diabetes

Do you know your risk?

-  Having a family member with type 2 diabetes (parent, grandparent, sibling or aunt or uncle) puts you at an increased risk of developing the condition too.

- Eating a diet high in carbohydrate, particularly refined carbohydrate (bread, pasta, chips, pap, pies and fast foods)

- If you are obese you are at least 20 times more likely to develop type 2 diabetes

- If you carry weight around your stomach or abdomen

- A lack of exercise/low levels of activity

- Smokers are 50% more likely to develop type 2 diabetes than non-smokers

- People of all ages are at risk of diabetes but that risk increases with age

- 65% of people who have diabetes live in cities

Test yourself: What is your risk of diabetes?

I am at risk – what now?

All adults with a body mass index (BMI) of 25 or higher, who are over the age of 45 or higher or have any of the risk factors listed above should be screened for diabetes at least every three years, according to the SEMDSA guidelines used in South Africa.

If you have had abnormal results previously or have multiple risk factors, your doctor may request more frequent screening.

The test involves pricking your finger for a sample of blood. It is quick and causes very little pain. Many pharmacies, clinics and medical aids offer free diabetes screenings as part of their services.

Use Health24's BMI Calculator

Take action to prevent diabetes!

Healthy eating is an important part of managing all types of diabetes. So much so that it is the theme of World Diabetes Day this year.

70% of type 2 diabetes can be prevented through a healthy lifestyle that includes exercise and a well-balanced diet, the International Diabetes Federation explains. 

Focus on including more of the following in your diet:

- Fresh fruit and vegetables

- Whole grains

- Lean meats and poultry

- Low fat milk and dairy products

- Seeds, nuts, legumes

- Plant oils

Try to cut back on or completely avoid the following foods:

- Refined carbohydrates

- Processed meats

- Foods high in sugar

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Diabetes may raise risk for staph infections

Researchers believe that diabetes might dampen the immune system, leaving people more vulnerable to staph blood infections.

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People with diabetes may be significantly more likely to develop potentially deadly "staph" blood infections than those withoutdiabetes, a new study suggests.

Type 1 diabetes more dangerous

As the Danish researchers explained, bacteria live on the skin and are normally harmless. However, the germs can cause dangerous infections if they enter the bloodstream.

In fact, the 30-day death rate from such infections is 20 percent to 30 percent, according to the research team from Aalborg University Hospital and Aarhus University Hospital.

In their new study, the researchers tracked the medical records of 30,000 people in Denmark over 12 years. 

Read: Prevalence of diabetes in South Africa

Overall, they found that people with any form of diabetes were almost three times more likely to acquire a staph blood infection outside a hospital, compared to those without diabetes.

The risk jumped to more than seven times higher among people with type 1 diabetes, and almost three times higher for those with type 2 diabetes.

About 95 percent of people with diabetes have the type 2 form of the disease, which is often (but not always) linked to obesity and involves a dysfunction in the body's ability to use insulin. About 5 percent of diabetes is type 1, where the body has lost its ability to produce insulin, the hormone that converts blood sugar to energy for cells.

Closer monitoring required

The new study also found that the combination of diabetes and related kidney problems boosted the odds for staph blood infection by more than fourfold, compared to people without these conditions. People with other diabetes-linked complications, such as heart and circulation problems and diabetic ulcers, were also at increased risk.

Read: Antibiotics linked to type 2 diabetes risk

The study was published in the European Journal of Endocrinology.

"It has long been a common clinical belief that diabetes increases the risk of S. aureus infection, but until now this has been supported by scant evidence," study author Jesper Smit said in a journal news release.

His team also found that the risk of staph bloodstream infection rose with the number of years a person had diabetes. Poor control of diabetes was another factor that upped the infection risk.

The findings suggest that long-term diabetes patients may require closer monitoring for infections, Smit's team said.

"Poor management of diabetes can lead to an impaired immune response," he explained. "This may be the reason why diabetes patients are at higher risk of infection. Similarly, diabetic patients often suffer associated illnesses – the burden of multiple health care problems can also increase susceptibility to infection." 

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Diabetic patch might replace finger prick

Diabetic patch might replace finger prick

Experimental technology monitors blood sugar and delivers diabetic medicine with microneedles.

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An experimental device might one day literally take the pain out of managing diabetes, Korean researchers say.

Painful blood-gathering process

The new invention uses a patch to monitor blood sugar levels via sweat, and delivers thediabetes drug metformin through the skin with microneedles.

"Diabetics are reluctant to monitor their blood glucose levels because of the painful blood-gathering process," said study author Hyunjae Lee, from Seoul National University in the Republic of Korea. "We highly focused on a non-invasive monitoring and therapy system for diabetics."

The findings were published online in the journal Nature Nanotechnology. The study team was led by Dae-Hyeong Kim, at Seoul National University. Funding for the study was provided by the Institute for Basic Science in the Republic of Korea.

Read: The importance of managing your diabetes

Currently, people with diabetes have two options for monitoring blood sugar (glucose) levels, said Richard Guy, who wrote an accompanying editorial in the journal. He's a professor of pharmaceutical sciences at the University of Bath in the United Kingdom.

One option is a blood glucose meter that requires a finger stick to draw out a drop of blood for testing. The other option is continuous glucose monitoring, which requires that a sensor be placed underneath the skin and worn constantly. Both of these options are invasive and can be painful.

Thin, flexible patch

Previously, a less invasive product called GlucoWatch pulled fluid through the skin to the device to measure blood sugar levels. However, that device was never commercially successful and was taken off the market, Guy said.

The Korean research team used a substance called graphene to develop a thin, flexible patch. Graphene conducts electricity, and can be transparent, soft and very thin, the researchers explained.

Read: Implantable insulin devices to revolutionise diabetes management

The patch also contains a variety of sensors that detect humidity, sweat glucose levels, pH and temperature, the researchers said. In addition, the patch contains heat-sensitive microneedles.

The patch uses sweat to determine "sweat glucose", which can be used to figure out blood glucose levels. Lee said the accuracy of the sweat glucose sensor is similar to that of home blood glucose meters in the United States.

Guy pointed out that someone who sweats a lot might pose a challenge for the patch.

But the researchers said they've already taken this into consideration. "We integrated a humidity sensor in the diabetes patch to check how much sweat is generated. So the person who perspires heavily wouldn't affect the sensing," said Tae Kyu Choi, another study author from Seoul National University.

Likewise, Choi said, the researchers accounted for someone who perspires very lightly.

Read: 5 ways to manage diabetes

The researchers tested the glucose-sensing ability of the patch in two humans and found the device was able to accurately measure blood sugar levels.

In the current version of the patch, the researchers used microneedles to deliver the diabetes drug metformin to mice. Over six hours, the drug – delivered through the skin – was able to drop blood sugar levels from 400 milligrams per decilitre to 120 milligrams per decilitre, the researchers said. For someone without diabetes, a normal blood sugar level taken randomly would generally be below 125 milligrams per decilitre, according to the U.S. National Library of Medicine.

High cost of device

Insulin the hormone necessary to lower blood sugar for people with type 1 diabetes wasn't used because it's a protein that would be difficult to deliver through microneedles because it's large, and it would be vulnerable to the heating process that allows the drug to be delivered through the skin, the study authors explained.

But, Guy said he expects that should this system go forward in development, other drugs that can lower blood sugar more effectively might be considered. "I think metformin was chosen as an example of a drug used in diabetics for the illustration of proof-of-concept," he said.

The researchers said they believe the device could be used by either type 1 or type 2 diabetics.

Read: Can apps make diabetes management easier?

However, Dr Joel Zonszein, director of the Clinical Diabetes Centre at Montefiore Medical Centre in New York City, said the cost of the device might make it very impractical for people with type 2 diabetes. And, he said, people with type 2 diabetes don't have to know what their blood sugar levels are as often as people with type 1 diabetes.

"They have proved the concept – that a sweat patch can do the monitoring and can deliver a drug transdermally [through the skin]. Trying to do something like this noninvasively really is the holy grail of diabetes. So, there may be a future for this, but there are many barriers to be overcome," Zonszein said.

The researchers said their next step is to improve the long-term stability and accuracy of the blood glucose sensor. Lee and Choi estimated it would be at least five years before they could solve any remaining obstacles and commercialise the device.

"The promise of a transdermal, minimally invasive glucose monitoring device is coming closer to fruition. I'd hope we'd see a new effort to bring a skin-based monitoring device for glucose to the market in the next few years," Guy said. "In contrast, such a system combined with drug delivery is, in my opinion, much further away."

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Causes of HIV/Aids

Causes of HIV/Aids

According to researchers, two viruses cause AIDS, namely HIV-1 and HIV-2. These viruses belong to a family called the retroviruses and are able to infect a person for the rest of that person's life.

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According to researchers, two viruses cause Aids, namely HIV-1 and HIV-2. HIV-1 is the predominant virus in most parts of the world, whereas HIV-2 is most commonly found in West Africa. These viruses belong to a family called the retroviruses. They are unique viruses in that they are able to insert their genetic material into the genetic material (DNA) of cells of the person that they have infected. In this way they are able to infect a person for the rest of that person's life.

To understand how the virus eventually causes Aids, see the section "Course of the disease".

Viruses that are very closely related to HIV are found in other primates (apes and monkeys). These viruses are called Simian Immunodeficiency Viruses (SIV). HIV-2 is genetically almost indistinguishable from the SIV found in sooty mangabeys. A very close genetic relative of HIV-1 has been found in chimpanzees. Therefore most scientists accept that the human immunodeficiency viruses are recently derived from these primate viruses. The earliest human blood sample found to contain HIV dates from 1959; this sample was collected in central Africa.

Based on molecular technology and the use of large computer programmes, scientists have been able to trace back the genetic origins of HIV-1 and HIV-2 and roughly pinpoint the time when these viruses first appeared in humans. The current theory is that sometime between 1930-1940 there was a "species-jump" of certain SIV's into human populations, probably through the practise of slaughtering, preparing and consuming of "bush meat" from monkeys in parts of Central and West Africa.

HIV is not as contagious as is often believed. The virus does not survive long outside the body and can only be transmitted through the direct exchange of certain body fluids such as blood, semen and vaginal fluid. The virus can gain access to the body at its moist surfaces ("mucous membranes") during sex, or through direct injection into the blood stream. Sex is the major mode of transmission of HIV worldwide.

HIV can be transferred from one person to another (transmitted) through:

•    Unprotected vaginal or anal intercourse with an infected person. 
•    A mother's infection passing to her child during pregnancy, birth or breastfeeding (called vertical transmission) – the risk of HIV passing from mother to child is approximately 30% if no preventative measure is used. 
•    Injection with contaminated needles, which may occur when intravenous drug users share needles, or when health care workers are involved in needleprick accidents. 
•    Use of contaminated surgical instruments, for example during traditional circumcision. 
•    Blood transfusion with infected blood. 
•    Contact of a mucous-membrane surface with infected blood or body fluid, for example with a splash in the eye (Note that the virus cannot penetrate undamaged skin.) 

If a person is exposed to HIV in one of the above ways, infection is not inevitable. The likelihood of transmission of HIV is determined by factors such as the concentration of HIV present in the body fluids. For example, although HIV has been detected in saliva, the concentration is thought to be too low for HIV to be transmitted through deep/wet kissing since it would require the exchange of almost one litre of saliva between individuals before there would be sufficient virus available for possible transmission. Additionally, a digestive protein in human saliva tends to inactivate the virus.

The risk of HIV transmission also depends on the stage of infection the HIV-positive sexual partner is in. Virus concentrations in blood and body fluids are highest when a person has very recently been infected with HIV, or otherwise very late in the disease, when Aids has developed. Very early after infection the virus can multiply rapidly as the immune system has not had time to respond and fight back, and late in the disease the virus can multiply rapidly because it has destroyed the immune system altogether. However, it is important to note that once a person is infected with HIV, their blood, semen or vaginal fluids are always infectious, for the rest of their lives.

Vulnerability to HIV infection through sexual contact is increased if a person has sores on the genitals, mouth or around the anus/rectum. These sores can be caused by rough intercourse, other sexually transmitted infections (STIs), gum disease or overuse of spermicides.

In heterosexual sex, women are more vulnerable to HIV infection because of the large mucous-membrane surface area of the vagina compared to that of the urethra (penile opening). Therefore, in regions where heterosexual sex is the main way HIV is transmitted (as in South Africa), approximately four women are infected for every three men that are infected.
Men who are circumcised have a slightly lower risk of being infected with HIV.

Fortunately, people can take action to reduce their risk of infection. For example, a person who uses a condom every time he or she has sex is at far lower risk of infection than someone who has unprotected sex.

The following outlines common sexual behaviours according to relative risk:

Very low risk

•    Kissing (if no blood is exchanged through cuts or sores). 
•    Touching (such as stroking, hugging or massage). 
•    Masturbation (including mutual masturbation). 
•    Oral sex on a man with a condom. 
•    Oral sex on a woman with a barrier method (such as plastic wrap, dental dam or a condom cut open).

Low risk

•    Wet/deep kissing (when sores or gum disease, and therefore blood, are present). 
•    Oral sex 
•    Vaginal sex with a male or female condom 
•    Anal sex with a male or female condom 

High risk

•    Anal intercourse without a condom 
•    Vaginal sex without a condom 

How HIV is not transmitted

Unfortunately, there are still many myths around HIV. A person cannot be infected through:

•    Mosquito bites 
•    Urine or sweat 
•    Public toilets, saunas, showers or swimming pools 
•    Sharing towels, linen or clothing 
•    Going to school with, socialising or working with HIV-positive people 
•    Sharing cutlery or crockery 
•    Sneezes or coughs 
•    Touching, hugging or dry kissing a person with HIV 
•    (Sexual) contact with animals, since HIV is strictly a human virus and is not carried by animals 

In South Africa, blood donated for transfusions or blood products is screened for antibodies to HIV and for viral RNA (genomes). Any contaminated blood is discarded. The probability of HIV infection via blood transfusion in this country is therefore extremely low, but transmission can still occur because even these highly sensitive tests cannot always detect very early HIV infection in a donor. (See "the window period" in the section on HIV tests.)

(Reviewed by Dr Diana Hardie, clinical virologist, National Health Laboratory Service and University of Cape Town, July 2010, Additional review by Dr Avron Urison, Medical Director of AllLife, 2013)

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