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A Practical Table to Compare Risks Between Oral Contraceptives

 MD-FM Thursday September 19, 2013 

 

 

GENERIQUE

Carillon

 

Sarah:

MD FM, Medical News from around the world with Peter Goodwin.

 

P1

PETER:

And with me is Sarah Maxwell. To begin with, women who use combined oral contraception are at four times greater risk of venous thrombosis

 

SARAH:

Yes, that’s according to a systematic review of 26 studies, published in the British Medical Journal, that showed the risk depended on the dose of estradiol and on the type of progesterone used. Lead study author, Olaf Dekkers:

 

Dekkers-1: The lowest risk of side effects is shown for pills containing 20 micrograms of oestradiol but that’s a dose that is often too low because it gives bleeding disturbances for women. Probably the best pill to give is a pill containing 30 micrograms of oestradiol. With respect to progesterone type, the risk is probably lowest for oestradiol combined with levonorgestrel, those are the second generation pills.” 

 

SARAH:

That was Dr. Olaf Dekkers, from Leiden University in the Netherlands. His team used a comprehensive table to compare the risk of thrombosis associated with different combined oral contraceptives. Indeed a lot has been published in this area, but this work combines all the information:

 

Dekkers-2: The main advantage of this study is that it now enables the clinicians, especially, to see what the risk is of different types of pills compared to whatever other pill they want. You can talk with the patients and say: well here are the risks when we compare all types of pills and together we can decide on what type of pill we are going to use.”

 

SARAH:

And Dr. Dekkers added that knowing about these risks is important at a population level:

 

Dekkers-3: At an individual level, if you are healthy and you’re 20 years old and you take the pill, then the rates of getting thrombosis in one year is only 1 in 10,000. But at a population level, if you consider that 100 million women take oral contraceptives, then you talk about 10 or 20,000 additional events and these events, in some cases, 2 or 3%, can be fatal.” 

 

SARAH:

Dr. Olaf Dekkers, from the Netherlands.

VIRGULE MUSICALE

 

P2

PETER:

News now from the International Congress of Nutrition, taking place in Granada, Spain, this week: For people who are overweight or obese, it appears some omega-3-compounds might help them to shed a few kilos

 

SARAH:

Yes, a group of researchers reported at the meeting that some omega-3-fatty acids can down-regulate the endocannabinoid system, a system that’s over-stimulated in many obese patients, giving them the urge to indulge in calorie-dense foods, and put on visceral fat

 

PETER:

Hmm, and did they mention which fatty acids these are?

 

SARAH:

Professor Sebastiano Banni, presented the findings in Spain and mentioned compounds which can be found in mother’s breast milk. But he says it’s not just one fatty acid in particular 

 

Banni: “We studied different forms of omega-3s, we are now concentrating on studying combinations. We don’t believe that just one fatty acid might change the world, there is no “bad fatty acid” or “very good fatty acid”, our diet is made up of many kinds of fatty acids, so it’s interesting to see what is the best combination.” 

 

SARAH:

That was Sebastiano Banni, from the University of Cagliari in Italy. He said researchers are now investigating ways to increase the production of specific compounds in our daily intake, in milk and cheese for example.

 

Banni: “We already found that feeding, for example, sheep by grass, in a natural way, will increase some fatty acids which then, in humans, may affect the endocanabinoid system”.

 

SARAH:

Professor Sebastiano Banni, from the University of Cagliari in Italy.

 

P3

PETER:

For obese people with non-alcoholic fatty liver disease, eating probiotic yogurt led to an 8.4% decrease in total cholesterol and a 7.5% decrease in LDL-C. That’s according to a small, randomized study, also presented at the Granada meeting, that compared daily consumption of conventional yogurt with yoghurt containing lactobacillus acidophilus La5 and bifidobacterium lactis Bb12.

 

 

VIRGULE MUSICALE

 

P4

PETER:

Simple lifestyle changes can have a beneficial impact on health-related parameters at the cellular level according to a study, published in the British Medical Journal, that showed dieting, better stress management and better social support were all associated with longer telomeres

 

SARAH:

Yes, telomeres are protective DNA and protein complexes at the ends of chromosomes that are said to regulate cell ageing. And, telomere shortening could be a prognostic marker for disease risk and progression, and for premature death. But how exactly does this work? Lead study author Dean Ornish, told MDFM more:

 

Ornish: “As our telomeres get longer, presumably our lives get longer and the risk of premature death and developing chronic diseases goes down accordingly. They have an effect not just preventing but actually reversing many conditions like heart disease and now even, at least to some degree, we are beginning to reverse the ageing process itself.”

 

SARAH:

That was Professor Dean Ornish, from San Francisco. His team followed 10 men who made comprehensive lifestyle changes and 25 controls. All men actually had indolent, slow-growing early-stage prostate cancer, and were being followed-up with watchful waiting rather than active therapy. This study wasn’t designed to follow their disease progression but to compare the effects of lifestyle intervention vs. watchful waiting on telomere length. At five years, the researchers analysed their blood samples:

 

Ornish: “We found that the telomere length increased by almost 10 percent in the group that made these lifestyle changes, when they actually got shorter in the control group. The more people changed their lifestyle, the longer the telomeres got. I think this gives many people new hope and new choices because so often people feel like “oh it’s all in my genes, there’s nothing I can do”, and it turns out that well in fact you can, and these processes are much more dynamic than we once had realized.”

 

SARAH:

Dean Ornish, founder and president of the Preventive Medicine Research Institute in California, who said that larger randomized trials are needed to confirm these findings.



VIRGULE MUSICALE

 

P5

PETER:

Both endoscopy and faecal occult-blood testing are effective ways to decrease colon-cancer mortality, according to two studies reported in the New England Journal of Medicine

 

SARAH:

Yes, one focused on colonoscopy and sigmoidoscopy looking at two cohorts followed for up to 22 years. Apparently sigmoidoscopy decreased the risk of developing colon cancer by 40%, colonoscopy by 55 to 60%. And both were associated with high reductions in colorectal cancer mortality, a 68% reduction in the case of colonoscopy.

 

PETER:

...and the other study?

 

SARAH:

Well it showed that annual faecal occult blood testing decreased mortality from colorectal cancer by one third. However, all-cause mortality did not decrease, a common issue that requires further investigation, according to the experts.

 

PETER:

Ok: so which one of all these methods is best then?

 

SARAH:

Well, there’s still debate on this; but Dr. Douglas Corley, who wrote an editorial in the New England Journal of Medicine, had this to say:

 

Corley: “Colon cancer screening really now has come of age. We’re getting more of the data that we needed from long-term studies to show that it’s effective. There are some studies that have suggested that if you have more than one method of offering screening, that more people will be screened. So the most important thing is perhaps not the method of the test but that someone actually receives screening. So the overall message at this point is that these studies support the implementation of screening programs, and there’s future studies that are directly comparing the tests which are available, to be able to determine which are the most effective overall.” 

 

SARAH:

That was Douglas Corley, from the San Francisco Medical Center in California.  



BREVE 1  

 

PETER:

Finally, in brief:

 

For patients with adolescent idiopathic scoliosis, wearing braces significantly reduced the progression of high-risk curve to the level at which surgery is needed. That’s according to a randomized trial — published in the New England Journal of Medicine, looking at 242 children and showed that, bracing led to treatment success in 72% of kids compared to 48% for those on simple observation. The longer the kids wore their braces, the higher the benefits.

 

And…..

 

BREVE 2

 

Scientists have developed a simple scoring system that can apparently predict which candidates for gastric bypass surgery are likely to achieve diabetes remission within five years. According to data reported in The Lancet Diabetes & Endocrinology, it relies on four factors that are independently predictive of remission: insulin use, age, haemoglobin A1c concentration and the type of anti-diabetic drugs.

 

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then from me Peter Goodwin, goodbye!

 

JINGLE FIN      

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Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

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