Damaged Small Nerves Lead To Damaged Longer Nerves

Today's post from painnewsnetwork.org (see link below) covers a story that appeared about three weeks ago on this blog but this time it's much more understandable for the casual neuropathy reader. It talks about the discovery that the early symptoms of neuropathy that are often diagnosed as small fibre neuropathy, are in fact a warning signal of much greater deterioration of the longer nerves in the future. Many of you reading this will be having a 'duh' moment of 'So tell us something we didn't already know!' However, medical science likes things neatly packaged and labelled and the idea that small fibre neuropathy could lead to damage of other nerve sorts and much wider symptoms was not easily accepted. It was always thought that the longer nerves degraded first but these recent studies show that in fact it is just as likely that the short nerves begin the process leading to longer nerve degeneration. It's an interesting article which if you have any of the tingling, burning symptoms we're so accustomed too, may apply to you too.

Neuropathy More Damaging Than Previously Thought
By Pat Anson, Editor April 11, 2016
 
A tingling, sometimes painful sensation in the hands and feet – the early stages of small fiber neuropathy -- may be more damaging to the peripheral nervous system than previously thought, according to new research published in JAMA Neurology.

A 3-year study by Johns Hopkins neurologists found that patients with small fiber neuropathy showed unexpected deterioration over the entire length of sensory nerve fibers, not just nerve fibers at the surface of the skin.

“I liken small fiber neuropathy to the canary in the coal mine,” says senior author Michael Polydefkis, MD, professor of neurology at the Johns Hopkins University School of Medicine and director of the Cutaneous Nerve Lab. “It signals the beginning of nerve deterioration that with time involves other types of nerve fibers and becomes more apparent and dramatically affects people’s quality of life. The results of this new study add urgency to the need for more screening of those with the condition and faster intervention.”

Nearly 26 million people in the United States have diabetes and about half have some form of neuropathy, according to the American Diabetes Association. Small fiber neuropathy can also be caused by lupus, HIV, Lyme disease, celiac disease or alcoholism.

Diabetic peripheral neuropathy causes nerves to send out abnormal signals. Patients feel pain or loss of feeling in their toes, feet, legs, hands and arms. It may also include a persistent burning, tingling or prickling sensation. The condition can eventually lead to injuries, chronic foot ulcers and even amputations.

Polydefkis and his colleagues found that small fiber nerve damage occurs even in patients with prediabetes, and the early symptoms of burning pain may be less benign than most clinicians think. Routine nerve tests, like nerve conduction, often fail to identify nerve damage because they mostly assess injury to large diameter nerve fibers.

In an effort to measure nerve damage more accurately, Johns Hopkins researchers took small samples of skin — the size of a large freckle — from 52 patients diagnosed with small fiber neuropathy and from 10 healthy controls. Skin samples were taken from the ankle, the lower thigh near the knee and the upper thigh. Three years later, samples from the same area in the same patients were taken for comparison.

Microscopic analysis of the skin samples showed that patients with small fiber neuropathy initially had fewer nerve fibers on the ankle compared to the upper thigh, demonstrating the most nerve damage was further down the leg. But after three years, researchers found that longer nerve fibers were also lost from the lower and upper thighs, something that was not expected.

“We are all taught in medical school that the longest nerves degrade first, and we show that this isn’t always the case,” says lead author Mohammad Khoshnoodi, MD, assistant professor of neurology at Johns Hopkins,

Patients with prediabetes or diabetes had at least 50 percent fewer small nerve fibers in their ankles initially than those participants with an unknown cause for their small fiber neuropathy, indicating these patients started the study with more damage to their small nerve fibers.

The patients with prediabetes continued to have worsening damage to their small nerve fibers over the course of the study, losing about 10 percent of their nerve fiber density each year at all sites tested along the leg. Patients with diabetes also lost similar rates of nerve fibers along the three sites of the leg.

“I expected that people with diabetes would do worse, but I didn’t really expect people with prediabetes to experience a similar rate of degradation of their small nerve fibers,” says Polydefkis.

Researchers caution that their study was small, and that other factors such as high blood sugar, smoking, high blood pressure and high cholesterol, may also have contributed to the decline in nerve fibers.

http://www.painnewsnetwork.org/stories/2016/4/11/neuropathy-more-damaging-than-previously-thought

EAT PEANUTS FOR A LONGER LIFE

If you're looking for a simple way to lower your risk of dying from a heart attack, consider going nuts.

Researchers at Vanderbilt University and the Shanghai Cancer Institute examined the association of peanut and nut consumption with mortality among low-income and racially diverse populations and found that intake of peanuts was associated with fewer deaths, especially from heart disease.

The study was published March 2 in JAMA Internal Medicine. The first author of the paper is Hung Luu, Ph.D., a post-doctoral fellow in the Division of Epidemiology, Vanderbilt University Medical Center. Senior author is Xiao-Ou Shu, M.D., Ph.D., associate director for Global Health at the Vanderbilt-Ingram Cancer Center (VICC) and professor of Medicine in the Department of Epidemiology.

"Nuts are rich in nutrients, such as unsaturated fatty acids, fiber, vitamins, phenolic antioxidants, arginine and other phytochemicals. All of them are known to be beneficial to cardiovascular health, probably through their anti-oxidative, anti-inflammatory and endothelial function maintenance properties," Shu said.

While research has previously linked nut consumption with lower mortality, those studies focused mainly on higher-income, white populations. This study was the first to discover that all races -- blacks, whites and Asians alike -- could potentially increase heart health by eating nuts and peanuts.

"In our study, we found that peanut consumption was associated with reduced total mortality and cardiovascular disease mortality in a predominantly low-income black and white population in the U.S., and among Chinese men and women living in Shanghai," Shu said.

This study was based on three large ongoing cohort studies. Participants included more than 70,000 Americans of African and European descent from the Southern Community Cohort Study (SCCS), who were mostly low-income, and more than 130,000 Chinese from the Shanghai Women's Health Study (SWHS) and the Shanghai Men's Health Study (SMHS).

Information on nut consumption was collected by structured questionnaires at the baseline survey. For participants in the SCCS, deaths were determined by linking with the National Death Index and Social Security Administration mortality files, and for participants in the SWHS/SMHS, by linking with the Shanghai Vital Statistics Registry and by conducting home visits. In total, more than 14,000 deaths were identified, with a median follow-up of 5.4 years in the SCCS, 6.5 years in the SMHS, and 12.2 years in the SWHS.

Peanut consumption was associated with decreased total mortality, particularly cardiovascular mortality (i.e., 17-21 percent reduction in total mortality, and 23-38 percent reduction in cardiovascular mortality for the highest quartile intake group compared to the lowest quartile group) across all three racial/ethnic groups, among both men and women, and among individuals from low-SES groups.

Because peanuts are much less expensive than tree nuts, as well as more widely available to people of all races and all socioeconomic backgrounds, increasing peanut consumption may provide a potentially cost-efficient approach to improving cardiovascular health, Shu said.

"The data arise from observational epidemiologic studies, and not randomized clinical trials, and thus we cannot be sure that peanuts per se were responsible for the reduced mortality observed," said William Blot, Ph.D., associate director for Cancer Prevention, Control and Population-based Research at VICC and a co-author of the study.

He did note that "the findings from this new study, however, reinforce earlier research suggesting health benefits from eating nuts, and thus are quite encouraging."

The American Heart Association recommends eating four servings of unsalted, unoiled nuts a week. However, nutrient-rich nuts are also high in calories, so don't eat too many if you're watching your weight. A serving size is a small handful or 1.5 ounces of whole nuts or 2 tablespoons of nut butter.

Living Longer With HIV And Neuropathy

Today's post from webmd.com (see link below) looks at how living with HIV in 2015 can mean living a long and normal life, although there are problems that can crop up thanks to either the virus or the medication - (neuropathy is one of them). It's pretty much aimed at the success stories with HIV - those on regular treatment, who have achieved an undetectable status. However, many millions across the world do not live in this luxurious position and are denied treatment and exposed to vicious stigmas and our thoughts should always go out to them. Worth a read both for those living with HIV and those who are lucky enough not to.

HIV as You Get Older
By R. Morgan Griffin WebMD Feature Reviewed by Melinda Ratini, DO, MS

By 2013, almost 30 percent of all people with HIV were age 50 or over. This greying of the HIV population shows how well today’s HIV treatments can work.

HIV makes aging itself more complicated. But plenty of people have had HIV for years, even decades, and are doing well.

"These days, we fully expect that someone with HIV will live a long, healthy life," says Christine A. Wanke, MD, professor of medicine and director of the nutrition and infection unit at Tufts University School of Medicine. "But that means they have to plan ahead and adopt the healthy habits to stay that way, just like anyone without HIV." 

HIV and Aging: 5 Common Challenges

As you get older with HIV, you may face issues including:

1. Other conditions. Just like anybody, getting older means you're more likely to have health problems, and HIV seems to bump up the risk even more. "HIV accelerates the aging process and magnifies its effects," says John G. Bartlett, MD, professor at the Johns Hopkins School of Medicine and director of its AIDS service. So HIV may make you more likely to get heart disease, diabetes, cancer, osteoporosis, kidney problems, and other conditions.

2. Drug interactions. Since you’re already taking medicines for HIV, additional drugs for other conditions can increase the chance of interactions.

3. Loss of support. Some people become more isolated as they age. That happens more often to people with HIV, who may also be dealing with embarrassment about the condition or strained family relationships. If you're alone and disconnected, you're more likely to get depressed.

4. Changing roles. Like many people without HIV, you may be caring for your aging parents. That can add emotional and financial pressures.

5. Difficulty adjusting. "I talk to people with HIV who say, 'I didn't expect to live to middle age,'" says Brad Hare, MD, director of the HIV/AIDS clinic at San Francisco General Hospital. "'But now I'm middle-aged and I'm probably going to live another 30 years.'" Many people who got HIV long ago didn't plan for a long life, and adjusting can be a challenge. For instance, you might not have saved for a longer life.

7 Steps to Take

1. See an HIV expert. The more your health is complicated by age and other conditions, the more crucial it is to have an expert overseeing your HIV care.

2. Get good routine medical care. Specialty HIV care is not enough. Because your risks of other medical problems are higher, keep on top of your general health, says Hare. Get your annual physicals, keep tabs on your blood pressure, cholesterol, and other tests your doctor recommends.

3. Avoid drug interactions. Make certain every doctor you see knows about every medication and supplement you take, including prescription drugs, over-the-counter products, vitamins, and natural products. Doctors may adjust your medicines, dosages, or schedules to prevent interactions.

4. Improve your lifestyle. To enjoy life as you age, stay fit. Exercise regularly, and if you smoke, stop.

5. Eat a healthy diet. Go for lots of fruits and vegetables, lean proteins, whole grains, and healthy fats. "Eating a heart-healthy diet makes sense for everyone," says Bartlett. "But because people with HIV have higher risks of heart disease, it makes even more sense for them."

6. Seek support. Having a support system of family and friends is key. Make an effort to stay connected. If close friends or family have died or moved away, work on making new friends. You might also connect through a support group.

7. Get help. Call your local health department to learn about local resources for people with HIV, says Hare. Your local Council on Aging is a good place to start; it can point you toward programs and services that could help. A financial planner may also help you work on savings and expenses.

http://www.webmd.com/hiv-aids/features/hiv-and-aging?page=2