Could yoga lessen prenatal depression?

 In a small pilot study, researchers at Brown University, Butler Hospital, and Women & Infants' Hospital have found evidence suggesting that yoga could help pregnant women with significant depression reduce the severity of the mood disorder.

Lead author Cynthia Battle said she learned in prior research that depressed pregnant women are often reluctant to use medications and some also have difficulty engaging in individual psychotherapy. When she asked them what other treatments they might find appealing, some mentioned yoga.

"This is really about trying to develop a wider range of options that suit women who are experiencing these kind of symptoms during pregnancy," said Battle, associate professor of psychiatry and human behavior in the Alpert Medical School of Brown and a psychologist at Butler and Women & Infants. "What we don't want to do is have people fall through the cracks."

A few small studies have also suggested that yoga and mindfulness-based approaches could help prevent or treat depression during pregnancy. Battle's study, published in the March-April issue of the journal Women's Health Issues, is an initial test of whether a 10-week program of prenatal yoga, structured to be similar to yoga programs available to pregnant women in many communities, could be feasible, acceptable, safe, and effective for mild to moderately depressed women.

"What we feel like we've learned from this open pilot trial is that prenatal yoga really does appear to be an approach that is feasible to administer, acceptable to women and their healthcare providers, and potentially helpful to improve mood," Battle said. "We found what we think are very encouraging results."

Importantly, this pilot study was not a blinded randomized controlled trial, which would provide stronger, more rigorous evidence, Battle said. She and second author Lisa Uebelacker have since led a small randomized controlled trial with similarly positive results that are now being written up for publication. They are seeking funding for a larger research study with investigators from Brown, Butler, Women & Infants, and Memorial Hospital in Pawtucket in order to gather more definitive evidence.

In the newly published pilot study, they worked with Rhode Island obstetricians and midwives to recruit 34 pregnant women with elevated depression symptoms. Women attended a program of prenatal yoga classes tailored for pregnant women by registered yoga instructors. Co-author Kaeli Sutton, for example, is a yoga expert who specializes in working with pregnant and postpartum women.

In addition to practicing yoga and mindfulness during the classes, women were also encouraged to do so at home.

At regular timepoints during the 10-week study, the researchers measured depressive symptoms in the women, participation in yoga classes, home yoga practice, and changes in mindfulness, again using a standardized questionnaire.

Only four women engaged in any other treatment for depression. The prenatal yoga program did not include any type of counseling or psychotherapy specifically to address depression.

All subjects received written medical clearance from their prenatal care provider before participating, and the researchers asked women at regular intervals about any adverse effects, such as physical strain or injuries, throughout the study. The women reported none.

Signs of efficacy

Though there was no control group to compare against, the study provides signs that prenatal yoga could be helpful, Battle said. One was the degree to which depressive symptoms declined during the 10-week program on two standardized scales. On the "QIDS" scale, in which a trained, objective rater evaluates responses, the women on average dropped from scores consistent with moderate depression (10-15) to scores well into the mild range (5-10). On the "EPDS" scale, which relies on self-reports, average scores fell similarly, from a level consistent with clinically significant depression (more than 10) to scores significantly under that threshold.

The study data also showed that the more prenatal yoga pregnant women did, the more they benefitted psychologically. It's the first study showing a proportional association.

The researchers also measured significant changes in some attributes of mindfulness, which many researchers believe is one mechanism by which yoga may reduce depression. Mindfulness involves directing one's attention to the present moment, noticing thoughts, feelings, or sensations, and avoiding judgment of those experiences.

Gathering more definitive evidence about how yoga and mindfulness may affect mood in pregnant women is a priority for the planned randomized, controlled trial. Battle said that five-year study design also calls for measuring levels of pro-inflammatory cytokines, which are biomarkers of stress.

The results of the pilot study show that a larger trial would be worthwhile, Battle said.

"This is not the definitive study where we can say that this is an efficacious frontline treatment, however it is a study suggesting that we know enough now to warrant the next, larger study," she said. "This is an important first step in trying to understand if this is a potentially viable treatment approach."

Women should consult a healthcare provider before pursuing any remedy for depression, the researchers noted.

Source:Brown University

UTSW neuroscientists identify cell type in the brain that controls body clock circadian rhythms

UT Southwestern Medical Center neuroscientists have identified key cells within the brain that are critical for determining circadian rhythms, the 24-hour processes that control sleep and wake cycles, as well as other important body functions such as hormone production, metabolism, and blood pressure.

Circadian rhythms are generated by the suprachiasmatic nucleus (SCN) located within the hypothalamus of the brain, but researchers had previously been unable to pinpoint which of the many thousands of neurons in the region were involved in controlling the body's timekeeping mechanisms.

"We have found that a group of SCN neurons that express a neuropeptide called neuromedin S (NMS) is both necessary and sufficient for the control of circadian rhythms," said Dr. Joseph Takahashi, Chairman of Neuroscience and Howard Hughes Medical Institute (HHMI) Investigator at UT Southwestern, who holds the Loyd B. Sands Distinguished Chair in Neuroscience.

The findings, published in the journal Neuron, may offer important targets for future treatments of diseases and problems related to circadian dysfunction, which range from jet lag and sleep disorders to neurological problems such as Alzheimer's disease, as well as metabolism issues and psychiatric disorders such as depression.

Key studies in the 1970s revealed that the SCN communicates and coordinates cells throughout the body to control circadian rhythms, but the SCN contains many neurons with different expression patterns of neuropeptides and neurotransmitters.

"Which of these neurons are responsible for producing circadian rhythms was a major unanswered question in neurobiology. This study marks a significant advancement in our understanding of the body clock" said senior author Dr. Masashi Yanagisawa, Adjunct Professor of Molecular Genetics, former HHMI Investigator at UT Southwestern, and current Director of the World Premier International Institute for Integrative Sleep Medicine at the University of Tsukuba in Japan.

NMS is a neuropeptide - a protein made of amino acids that neurons, which are cells in the brain, use to communicate. Researchers created unique mouse models to determine that NMS-expressing neurons act as cellular pacemakers to regulate circadian rhythms. Specifically, the research team found that modulating the internal clock in just the NMS neurons altered the circadian period throughout the whole animal. In addition, the study provided new insights into the mechanisms by which light synchronizes body clock rhythms.

Dr. Takahashi identified and cloned the first mammalian gene -- called Clock--related to circadian rhythms. Since then, the Takahashi lab has determined that disruptions in the Clock and Bmal1 genes in mice can alter the release of insulin by the pancreas, resulting in diabetes, and they determined the 3-D structure of the CLOCK-BMAL1 protein complex, which are considered to be the batteries of the biological clock.

Dr. Yanagisawa first identified the important role that endothelin plays on the cardiovascular system, and later, with his discovery of orexin, showed that sleep/wakefulness is controlled by a single neuropeptide. His lab has since identified numerous receptors involved in the regulation of appetite and blood pressure, as well as other neuropeptides that play an important role in the regulation of energy metabolism, stress responses, emotions, and other functions.

Source:UT SOUTHWESTERN MEDICAL CENTER

Early Screening, the Key to Prevent Type 2 Diabetes

Diabetes prevention as the focus, Centre for Disease Control (CDC) and the American Medical Association (AMA) have teamed up. The partnership called Prevent Diabetes STAT — for Screen, Test, Act, Today will reach to people with prediabetes and stop the progression to type 2 diabetes.

 

"The time to act is now. We need a national, concerted effort to prevent additional cases of type 2 diabetes in our nation - and we need it now. We have the scientific evidence and we've built the infrastructure to do something about it, but far too few people know they have prediabetes and that they can take action to prevent or delay developing type 2 diabetes," said Ann Albright, director of CDC's Division of Diabetes Translation. 

CDC and the AMA, have taken efforts to develop a toolkit to help health care providers screen and refer high-risk patients to area diabetes prevention programs. The toolkit and other prevention information is available online, and there is also an online screening toolkit for patients to help them determine their type 2 diabetes risk. 
 Source:AMA

Vegetarian Diet Associated With Reduced Risk for Colorectal Cancer

Vegetarian diets are associated with a lower incidence of colorectal cancer, claims a study in JAMA Internal Medicine.

Nearly 80,000 adults from the Adventist Health Study 2 completed food-frequency questionnaires at baseline and then were divided into five dietary groups: vegan (8% of the population), lacto-ovo vegetarian (29%), pesco-vegetarian (10%), semi-vegetarian (6%), and non-vegetarian (48%).

During 7 years' follow-up, researchers documented 490 cases of colorectal cancer. Compared with non-vegetarians, all vegetarians combined had a significantly reduced risk for colorectal cancer (adjusted hazard ratio, 0.78). When examined by type of vegetarian diet, only pesco-vegetarians had a significant reduction in risk (hazard ratio, 0.57). 

"The evidence that vegetarian diets ... may be associated with a reduced risk of colorectal cancer, along with prior evidence of the potential reduced risk of obesity, hypertension, diabetes, and mortality, should be considered carefully in making dietary choices and in giving dietary guidance," the authors conclude.
 Source:JAMA 

High-Calorie Breakfast, Low-Energy Dinner can Help Control Blood Sugar

High-caloric breakfast and low-energy dinner can help control blood sugar spikes all day, reveals a new study.

According to Tel Aviv University's Prof. Daniela Jakubowicz and Dr. Julio Wainstein of the Wolfson Medical Center's Diabetes Unit, Prof. Oren Froy of the Hebrew University of Jerusalem, and Prof. Bo Ahren of Lund University in Sweden, the combined consumption of a high-energy breakfast and a low-energy dinner decreases overall daily hyperglycaemia in type-2 diabetics. 

The results of the study showed that post-meal glucose elevations were 20 percent lower and levels of insulin, C-peptide, and GLP-1 were 20 percent higher in participants on the B diet compared with those on the D diet. 

Despite the fact that both diets contained the same calories, blood glucose levels rose 23 percent less after the lunch preceded by a large breakfast in the study. 

The researchers are currently engaged in an extended study of the benefits of high-energy breakfast and reduced-calorie dinners over time. 
Source:
The study is published in Diabetologia.