Incipient's article

Source: University of Oxford

A global study of 12 million people has found diabetes increases the risk of heart failure and this increase is greater for women than men. Researchers from The George Institute for Global Health determined that this differential was greater in type 1 than type 2 diabetes. Type 1 diabetes is associated with a 47% excess risk of heart failure in women compared to men, whilst type 2 diabetes has a 9% higher excess risk of heart failure for women than men.

The findings published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]) highlights the need for further sex-specific research into diabetes and how the condition can potentially contribute to heart complications.

According to the International Diabetes Federation (IDF), currently 415 million adults world-wide live with diabetes – with approximately 199 million of them being women. The IDF expects by the year 2040 around 313 million women will be suffering from the disease. Diabetes is the ninth leading cause of death in women and claims 2.1 million female lives every year, more so than men. The number one leading cause of death for women is heart disease.

'It is already known that diabetes puts you at greater risk of developing heart failure but what our study shows for the first time is that women are at far greater risk – for both type 1 and type 2 diabetes,' said lead author and research fellow Dr Toshiaki Ohkuma from The George Institute.

'The increased risk of heart failure following a diabetes diagnosis is significantly greater in women than men which highlights the importance of intensive prevention and treatment of diabetes in women. Further research is required to understand the mechanisms underpinning the excess risk of heart failure conferred by diabetes [particularly type 1] in women and to reduce the burden associated with diabetes in both sexes.'

Key findings:
• Women with type 1 diabetes were associated with a more than 5-fold increased risk of heart failure compared with those without diabetes. For men, the risk was 3.5-fold higher.
• Corresponding increases in risks for heart failure associated with type 2 diabetes were 95% in women and 74% in men.
• Researchers also found that both type 1 and type 2 diabetes were stronger risk factors for heart failure in women than men.
• Type 1 diabetes was associated with a 47% greater excess risk of heart failure in women compared with men.
• Type 2 diabetes was associated with a 9% greater excess risk of heart failure in women than men.
*Data compiled from 10 countries: Australia, US, UK, Italy, Sweden, Canada, Japan, China, Taiwan and Korea.

According to Diabetes Australia, the prevalence of diabetes is now so widespread that it has become the major health crisis of the 21st Century. It is the largest challenge facing the Australian health system with around 1.7 million sufferers nationwide. More than 119,000 Australians are living with type 1 diabetes, an autoimmune condition, whereas 1.3 million Australians are living with type 2 diabetes, the effects of which can be exacerbated by lifestyle factors such as poor diet and lack of exercise. It’s estimated that the number of people suffering from diabetes globally will increase to 642 million by 2040.

Study co-author Dr Sanne Peters, of The George Institute for Global Health at the University of Oxford, said there are a number of reasons why women with diabetes are at greater risk of heart complications. 'Women were reported to have two years’ longer duration of prediabetes than men and this increased duration may be associated with greater excess risk of heart failure in women' said Dr Peters.

'Some major concerns are that women are also being undertreated for diabetes, are not taking the same levels of medications as men and are less likely to receive intensive care.'

The IDF reports that girls and women with diabetes experience a range of challenges. Gender roles, power imbalances, socioeconomic inequalities resulting in poor diet and lack of physical activity can all influence vulnerability to diabetes.

Women’s limited access to health services and lack of pro-activity when it comes to seeking treatment for health problems can also amplify the impact of diabetes, particularly in developing countries.

Diabetes is one of the leading causes of cardiovascular disease, blindness, kidney failure and lower-limb amputation. In pregnancy, poorly controlled diabetes increases the risk of maternal and foetal complications. Women with type 2 diabetes also have a significantly increased risk of depression in comparison to men.

The George Institute has been leading gender specific research and has already shown women with diabetes have a significantly greater excess risk of stroke and coronary heart disease as well as the non-cardiovascular complications of dementia and cancer than men. It is currently investigating gender differences in stroke as well as other chronic diseases.

The full paper, Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals can be read in Diabetologia.

Source: Harvard University

Some people over age 60 have few, if any, classic hypothyroidism symptoms, while others experience the same symptoms younger people do. Still others have hypothyroidism symptoms that are not typical at all, making the diagnosis even more difficult. Any of the following signs and symptoms can indicate hypothyroidism in an older person.

Unexplained high cholesterol. High cholesterol is sometimes the only evidence of an underactive thyroid in an older person. The problem might be diagnosed as a cholesterol disorder rather than hypothyroidism. Because this sign may stand alone, high cholesterol warrants a thyroid evaluation.

Heart failure. Reduced blood volume, weaker contractions of the heart muscle, and a slower heart rate—all caused by low thyroid hormone levels—can contribute to heart failure, a serious condition that occurs when your heart can't pump out enough blood to meet the needs of your body. The ineffective pumping also causes blood to back up in the veins that return blood to the heart. Blood backs up all the way into the lungs, which causes them to become congested with fluid. Symptoms of heart failure include breathlessness, swelling in the ankles, weakness, and fatigue.

Bowel movement changes. An older person with hypothyroidism might have constipation because stool moves more slowly through the bowels. A less common hypothyroidism symptom is frequent bouts of diarrhea—a problem more typically associated with hyperthyroidism. Some people with an autoimmune thyroid disease such as Hashimoto's also have celiac disease, another autoimmune condition that can cause diarrhea.

Joint or muscle pain. Vague joint pain is a classic hypothyroidism symptom. It sometimes is the only symptom of hypothyroidism in an older person. Many people experience general muscle aches, particularly in large muscle groups like those in the legs.

Psychiatric problems. Clinical depression—a common symptom in younger people with hypothyroidism—can also affect older people with the condition. The difference is that in older people it can be the only hypothyroidism symptom. Some older adults also develop psychosis with delusional behavior or hallucinations.

Dementia. Debilitating memory loss that is often, but not always, accompanied by depression or psychosis can also be the lone symptom of hypothyroidism. If you or a loved one is being evaluated for dementia, make sure that a thyroid test is part of the evaluation.

Balance problems. Hypothyroidism can lead to abnormalities in the cerebellum (a region at the back of the brain that's involved in motor control). This may cause problems with walking in older people.

Source: Cornell University College of Veterinary Medicine

The Special Needs of the Senior Cat

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Just as people are living longer than they did in the past, cats are living longer too, and there is every reason to expect that the "graying" cat population will continue to grow.

How old is my cat in human years?
Cats are individuals and, like people, they experience advancing years in their own unique ways. Many cats begin to encounter age-related physical changes between seven and ten years of age, and most do so by the time they are 12. The commonly held belief that every "cat year" is worth seven "human years" is not entirely accurate. In reality, a one-year-old cat is physiologically similar to a 16-year-old human, and a two-year-old cat is like a person of 21. For every year thereafter, each cat year is worth about four human years. Using this formula, a ten-year-old cat is similar age wise to a 53-year-old person, a 12-year-old cat to a 61-year-old person, and a 15-year-old cat to a person of 73.

Advancing age is not a disease
Aging is a natural process. Although many complex physical changes accompany advancing years, age in and of itself is not a disease. Even though many conditions that affect older cats are not correctable, they can often be controlled. The key to making sure your senior cat has the healthiest and highest quality of life possible is to recognize and reduce factors that may be health risks, detect disease as early as possible, correct or delay the progression of disease, and improve or maintain the health of the body's systems.

What happens as my cat ages?
The aging process is accompanied by many physical and behavioral changes:

• Compared to younger cats, the immune system of older cats is less able to fend off foreign invaders. Chronic diseases often associated with aging can impair immune function even further.
• Dehydration, a consequence of many diseases common to older cats, further diminishes blood circulation and immunity.
• The skin of an older cat is thinner and less elastic, has reduced blood circulation, and is more prone to infection.
• Older cats groom themselves less effectively than do younger cats, sometimes resulting in hair matting, skin odor, and inflammation.
• The claws of aging felines are often overgrown, thick, and brittle.
• In humans, aging changes in the brain contribute to a loss of memory and alterations in personality commonly referred to as senility. Similar symptoms may be seen in elderly cats: wandering, excessive meowing, apparent disorientation, and avoidance of social interaction.
• For various reasons, hearing loss is common in cats of advanced age.
• Changes in the eyes. A slight haziness of the lens and a lacy appearance to the iris (the colored part of the eye) are both common age-related changes, but neither seems to decrease a cat's vision to any appreciable extent. However, several diseases, especially those associated with high blood pressure, can seriously and irreversibly impair a cat's ability to see.
• Dental disease is extremely common in older cats and can hinder eating and cause significant pain.
• Although many different diseases can cause a loss of appetite, in healthy senior cats, a decreased sense of smell may be partially responsible for a loss of interest in eating. However, the discomfort associated with dental disease is a more likely cause of reluctance to eat.
• Feline kidneys undergo a number of age-related changes that may ultimately lead to impaired function; kidney failure is a common disease in older cats, and its symptoms are extremely varied.
• Degenerative joint disease, or arthritis, is common in older cats. Although most arthritic cats don't become overtly lame, they may have difficulty gaining access to litter boxes and food and water dishes, particularly if they have to jump or climb stairs to get to them.
• Hyperthyroidism (often resulting in overactivity); hypertension (high blood pressure, usually a result of either kidney failure or hyperthyroidism), diabetes mellitus; inflammatory bowel disease; and cancer are all examples of conditions that, though sometimes seen in younger cats, become more prevalent in cats as they age.

Is my cat sick, or is it just old age?
Never assume that changes you see in your older cat are simply due to old age, and are therefore untreatable. Owners of older cats often notice changes in their cat's behavior, but consider these changes an inevitable and untreatable result of aging. However, any alteration in your cat's behavior or physical condition should alert you to contact your veterinarian.

Disease of virtually any organ system, or any condition that causes pain or impairs mobility can contribute to changes in behavior. For example:

• A fearful cat may not become aggressive until it is in pain (e.g., from dental disease) or less mobile (e.g., from arthritis).
• The increased urine production that often results from diseases common to aging cats (e.g., kidney failure, diabetes mellitus, or hyperthyroidism) may cause the litter box to become soiled more quickly than expected. The increased soil and odor may prompt cats to eliminate in inappropriate areas. .
• Many cats that do not mark their territory with urine may begin to do so if a condition like hyperthyroidism develops.
• Cats with painful arthritis may have difficulty gaining access to a litter box, especially if negotiating stairs is required. Even climbing into the box may be painful for such cats, prompting them to eliminate in inappropriate areas.
• Older cats may be more sensitive to changes in the household since their ability to adapt to unfamiliar situations diminishes with age.

How can I help keep my senior cat healthy?
Close observation is one of the most important tools you have to help keep your senior cat healthy. You may wish to perform a basic physical examination on a weekly basis. Ask your veterinarian to show you how to do it and what to look for. You will find it easier if you just make the examination an extension of the way you normally interact with your cat. For example, while you are rubbing your cat's head or scratching its chin, gently raise the upper lips with your thumb or forefinger so you can examine the teeth and gums. In the same way, you can lift the ear flaps and examine the ear canals. While you are stroking your cat's fur, you can check for abnormal lumps or bumps, and evaluate the health of the skin and coat.

Daily Brushing
Daily brushing or combing removes loose hairs, preventing them from being swallowed and forming hairballs. Brushing also stimulates blood circulation and sebaceous gland secretions, resulting in a healthier skin and coat. Older cats may not use scratching posts as frequently as they did when they were younger; therefore, nails should be checked weekly and trimmed if necessary.

Daily Tooth Brushing
Brushing your cat's teeth with a pet-specific toothpaste or powser is the single most effective way to prevent dental disease. Dental disease is more common in older cats and can lead to other health problems, so maintaining oral health is important. Most cats will allow their teeth to be brushed, although it may be necessary to gradually introduce your cat to tooth brushing over several weeks to months. Watch this video for instructions on how to brush your cat's teeth.

Proper Nutrition
Many cats get heavier or even obese as they age. If your cat is overweight, you should ask your veterinarian to help you modify the diet so that a normal body condition can be restored. Other cats actually become too thin as they get older. Weight loss can be caused by a variety of medical problems such as kidney failure, and special diets may be helpful in managing these problems.

Reducing Stress
Reducing environmental stress whenever possible is very important since older cats are usually less adaptable to change. Special provisions should be made for older cats that must be boarded for a period of time. Having a familiar object, such as a blanket or toy, may prevent the cat from becoming too distraught in a strange environment. A better alternative is to have the older cat cared for at home by a neighbor, friend, or relative. Introducing a new pet may be a traumatic experience for older cats, and should be avoided whenever possible. Moving to a new home can be equally stressful, however, stress can be alleviated by giving the older cat more affection and attention during times of emotional upheaval.

Cats are experts at hiding illness, and elderly cats are no exception. It is common for a cat to have a serious medical problem, yet not show any sign of it until the condition is quite advanced. Since most diseases can be managed more successfully when detected and treated early in their course, it is important for owners of senior cats to carefully monitor their behavior and health.

How can my veterinarian help?
Just as your observations can help detect disease in the early stages, so too can regular veterinary examinations. Your veterinarian may suggest evaluating your healthy senior cat more frequently than a younger cat. If your cat has a medical condition, more frequent evaluations may also be necessary. During your cat's examination, the veterinarian will gather a complete medical and behavioral history, perform a thorough physical examination in order to evaluate every organ system, check your cat's weight and body condition, and compare them to previous evaluations. At least once a year, certain tests, including blood tests, fecal examination, and urine analysis, may be suggested. In this way, disorders can be found and treated early, and ongoing medical conditions can be appraised. Both are necessary to keep your senior cat in the best possible health.

Should I adopt an older cat?
A special group of senior cats that deserves particular attention is older cats in shelters. While young cats and kittens are attractive to most potential adopters due to their cuteness and playfulness, senior cats are often overlooked by people considering adopting a cat. If people keep their minds open, they will find that there are countless older cats that would make excellent pets and would brighten up any home. Older cats in shelters are often more calm, are more likely to be litter trained, and can provide wonderful companionship to anyone kind enough to take them into their home. The next time you are at the shelter, take some time to check out these mature felines. Taking them home can make both of your lives richer, happier, and more satisfying.

Source: Harvard University

Probiotics can do more than improve your gut health. They also may indirectly enhance your brain, too.

Research shows that the gut and brain are connected, a partnership called the gut-brain axis. The two are linked through biochemical signaling between the nervous system in the digestive tract, called the enteric nervous system, and the central nervous system, which includes the brain. The primary information connection between the brain and gut is the vagus nerve, the longest nerve in the body.

The gut has been called a "second brain" because it produces many of the same neurotransmitters as the brain does, like serotonin, dopamine, and gamma-aminobutyric acid, all of which play a key role in regulating mood. In fact, it is estimated that 90% of serotonin is made in the digestive tract.

What affects the gut often affects the brain and vice versa. When your brain senses trouble—the fight-or-flight response—it sends warning signals to the gut, which is why stressful events can cause digestive problems like a nervous or upset stomach. On the flip side, flares of gastrointestinal issues like irritable bowel syndrome (IBS), Crohn's disease, or chronic constipation may trigger anxiety or depression.

The brain-gut axis works in other ways, too. For example, your gut helps regulate appetite by telling the brain when it's time to stop eating. About 20 minutes after you eat, gut microbes produce proteins that can suppress appetite, which coincides with the time it often takes people to begin feeling full.

How might probiotics fit in the gut-brain axis? Some research has found that probiotics may help boost mood and cognitive function and lower stress and anxiety. For example, a study published online Nov. 10, 2016, by Frontiers in Aging Neuroscience found that Alzheimer's patients who took milk made with four probiotic bacteria species for 12 weeks scored better on a test to measure cognitive impairment compared with those who drank regular milk.

A small 2013 study reported in the journal Gastroenterology found that women who ate yogurt with a mix of probiotics, twice a day for four weeks, were calmer when exposed to images of angry and frightened faces compared with a control group. MRIs also found that the yogurt group had lower activity in the insula, the brain area that processes internal body sensations like those emanating from the gut.

It's too early to determine the exact role probiotics play in the gut-brain axis since this research is still ongoing. Probiotics may not only support a healthier gut, but a healthier brain, too.