Judy Siegel Itzkovich
I am a 54-year-old woman, with type-2 diabetes (my H2A1B is about 7). I wonder whether taking fish oil (omega 3) would be beneficial and protect me from cardiovascular disease, which I do not have, or be good for my health in general. F.T, Jamaica
Howard Rice, a veteran Israeli pharmaceutical consultant, answers:
To start with, the ideal level of HbA1c – glycated hemoglobin, which tells you your average level of blood sugar over the past two to three months – should be below 6.4. This is the accepted limit for “pre-diabetes. Above IS diabetes. Although your level is about 7, you should try to keep in below 7. Try to reach the level of 6.4. I say this since you are relatively young, and many problems could be avoided by reaching a lower level. It’s easily said, but try with regular exercise and an appropriate diet.
Omega-3 fatty acids are found as EPA (Eicosapentaenoic acid) and DHA (docosahexaenoic acid), both of which are found primarily in certain fish. Omega-3 ALA (alpha-linolenic acid) fatty acid, is found in some nuts and seeds.
Your body need these fatty acids –known as essential fatty acids— to function. One of the problems with diabetes is the risk of heart disease, and omega 3 can only benefit. Helps avoid this by lowering triglycerides. A British study found that omega 3 promotes healthier gut-bacteria-reducing obesity in women and therefore also diabetes type A recent Harvard University study also found that omega 3 raises levels of a hormone called adiponectin, which increases insulin sensitivity so this may control type 2 diabetes. However more research still has to be done.
It is certain, however, that all three types of omega 3 oils reduce inflammation (this can prevent stroke) and reduce insulin resistance (diabetes). One also needs to eat foods with omega 6 –the other type of polyunsaturated fatty acids found in meat and other plant-eating animals in a ratio of one part of omega 3 to four parts omega 6, but this is another story!
My question has to do with secondary lymphedema from breast cancer treatment 22 years ago. It has gradually gotten worse, now extending down into the torso. Are there any treatments other than manual lymph drainage, sleeves, wrapping and pumps? I am currently using all those options, with no real improvements, though the pain has been lessened. V.S., via email.
Prof. Tamar Peretz, head of the Hadassah Medical Organization’s Sharett Institute of Oncology and a leading breast cancer expert in Jerusalem, replies:
Unfortunately, there are no other therapies. I am sorry that I cannot help more.
Our 10-year-old son is extremely sensitive to touch. Doctors, who diagnosed the problem as neuropathic pain, have not been able to suggest anything in his case. Is there any promising research dealing with this problem? C.R., Philadelphia, Pennsylvania, US.
Judy Siegel-Itzkovich replies
Yes, there is hope in recent research. A study led by Boston Children’s Hospital and the US National Institute of Mental Health) may open up new opportunities for treating neuropathic pain, a difficult-to-treat type of chronic pain due to damage to the nervous system that can make the lightest touch intensely painful. Writing in the prestigious journal Nature a few weeks ago, scientists led by Dr. Zhigang He and Dr. Clifford Woolf showed that neurons that originate in the brain’s cortex influence sensitivity to touch. The circuit could help explain why mind-body techniques to control pain seem to help many people.
“We know that mental activities of the higher brain – cognition, memory, fear and anxiety – can cause you to feel more or less pain, said Woolf. “Now we’ve confirmed a physiological pathway that may be responsible for the extent of the pain. We have identified a volume control in the brain for pain — now we need to learn how to switch it off.”
Pain sensation was previously thought to originate with neurons in the spinal cord receiving sensory information from the body and relaying it on to the brain. The new study found that a small group of neurons in the cortex can amplify touch sensation, sending projections to the same parts of the spinal cord that receive tactile sensory information from the body (known as the dorsal horns). The anatomy of this circuit has been known for some time, but no one actually looked at its function before, He continued.
“In normal conditions, the touch and pain layers of the spinal cord are strongly separated by inhibitory neurons,” added Dr. Alban Latremoliere, one of four co-first authors on the paper. “After nerve injury, this inhibition is lost, leading to touch information activating pain neurons. When the spinal neurons that are supposed to be pain-only send this information to the brain, we feel pain.”
The researchers believe that the cortical neurons they identified could be a potential target for treating the tactile component of neuropathic pain, via drugs or possibly brain electrical stimulation, breaking a feedback loop that introduces and exaggerates the pain response to normally non-painful touch.
When the team severed these neurons or silenced them genetically in a mouse model of neuropathic pain, the mice stopped recoiling from light, innocuous touches, such as stroking with a soft paintbrush or placement of a bit of tape on the bottom of a foot. But the mice retained their sensitivity to truly painful stimuli, reflexively withdrawing their paws when exposed to heat, cold or pinpricks.
They used recently developed technologies to visualize and target specific groups of neurons in the brain and spinal cord. This made it possible for them to observe the results when different neurons were activated or silenced in a mouse model and observe which circuits were activated when mice were exposed to noxious or innocuous stimuli.
“Our findings might help us target the stimulation to particular areas or groups of neurons,” said He. “It might be interesting to look at clinical data and try to replicate the stimulation in animals, and see what kind of stimulation would silence these neurons.”
With functional imaging technologies, investigators could probe what kinds of interventions maximally inhibit this circuit, added Woolf.
“We now have the ability to silence or activate whole groups of neurons and image their patterns of electrical firing with single-neuron resolution. None of this was possible 10 years ago.”
If you want an Israeli expert to answer your medical questions about preventing or treating illness, write to Breaking Israel News health and science senior reporter Judy Siegel-Itzkovich at judy[at]israel365.com with your initials, age, gender and place of residence and details of the medical condition, if any.