Effects of Protein Intake on Renal Function and on the Development of Renal Disease

One of the major functions of the kidney is the elimination Of the products of protein metabolism. It is not surprising, therefore, that protein intake exerts many diverse effects on the kidney. Most attention has been directed toward the role of protein intake in chronic renal failure. For at least a century, it has been known that reducing protein intake will ameliorate the symptoms of chronic renal failure, provided the reduction is not severe enough to induce protein deficiency. In recent years, much effort has been directed toward defining the optimum protein intake for patients with chronic renal failure, with the aim of slowing the rate of progression toward the end stage. Despite many reports, it is still not firmly established that protein restriction slows disease progression, although the bulk of available evidence supports this conclusion (for example, Fouque et al., 1992; Levey et al., 1996). In this review, however, attention will be limited to the effects of protein intake on the initiation of renal disease.

There are three ways in which protein intake may play a role in the development of renal disease: promotion of nephrolithiasis, enhancement of the morbidity of acute renal failure, and acceleration of glomerulosclerosis.

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Institute of Medicine’s Forum on Microbial Threats convened a public workshop on May 20-21, 2008, to examine Dr. Lederberg’s - scientist, Nobel laureate who died on February 2, 2008 - scientific and policy contributions to the marketplace of ideas in the life sciences, medicine, and public policy. The resulting workshop summary, Microbial Evolution and Co-Adaptation, demonstrates the extent to which conceptual and technological developments have, within a few short years, advanced our collective understanding of the microbiome, microbial genetics, microbial communities, and microbe-host-environment interactions.

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Pathogen Evolution

As Lederberg (2000) observed, the host-microbe relationship is a dynamic equilibrium. Physiological or genetic changes in either partner may prompt commensal microbes to invade the tissue of their host, thereby triggering an immune response that destroys the invaders, but may also injure or kill the host. As they explored this process from the perspectives of pathogen and host, the workshop speakers featured in this chapter proposed a variety of possible evolutionary routes to the host-microbe relationships that underlie infectious diseases.

The chapter’s first paper, by Stanley Falkow of Stanford University, considers the nature of bacterial pathogenicity as it has been viewed historically, and as revealed by his research and that of his colleagues at Stanford University. He explains how key discoveries—beginning with Lederberg’s fundamental work on bacterial genetics—shaped the developing field of molecular biology, and more specifically, Falkow’s nearly 50 years of research on the genetic basis of bacterial pathogenicity.

Using the tools of molecular genetics to study Salmonella, Falkow and coworkers have observed how bacteria manipulate host cell functions, how horizontal gene transfer shapes pathogen specialization, and how inherited pathogenicity islands transform commensal bacteria into pathogens. Having screened the entire Salmonella genome for genes that are associated with different stages of infection with a microarray-based negative selection strategy, they have identified many pathogen genes expressed in the multistage process of host invasion. Using a mouse model, they have also identified host genes and gene pathways expressed in response to Salmonella infection.

Falkow also considers the importance of the microbes he refers to as “commensal pathogens”: bacterial species (e.g., Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b, Streptococcus pyogenes) that typically inhabit the human nasopharynx without symptom, but sometimes cause disease. Their existence raises a host of scientific questions regarding the relationship between microbial pathogenicity, infectious disease, and immune function—questions that, he argues, should be approached by studying microbial pathogenicity as a biological phenomenon, and not merely from the perspective of its role in causing disease.

Just as there is more to microbial pathogenicity than disease, there is more to infectious disease than the actions of pathogens on host cells and systems. The chapter’s second paper, coauthored by Elisa Margolis and workshop speaker Bruce Levin of Emory University, considers the host response to microbial virulence, which, the authors note, does not correspond to simple evolutionary models. They examine why bacteria harm the (mostly human) hosts they need for their survival, offering evidence that “much of the virulence of bacterial infections can be blamed on the seemingly misguided overresponse of the immune defenses.”

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Dr. Tim Byers: I’m going to hit the high points of the discussion of the tobacco and obesity group and then ask a couple of specific questions for some final discussion. The group felt that we’re not serious about public health education in either tobacco or nutrition, given the size of the budgets for the efforts that we need. It’s said that nutrition education doesn’t work. Well, we have never really tried it, so maybe it works, maybe it doesn’t. To adequately fund marketing of a new product, we spend tens and tens of millions of dollars. To adequately fund nutrition, or tobacco education for that matter, it is going to be at least that much. So, that was an important point. Along those lines, we were urged, even during an economic downturn for public support for things like this, to continue to be very assertive and not apologetic about advocating for resources in these areas.

Another comment was that there is really not a single entity or organization empowered or resourced to do the job of primary prevention for tobacco and obesity and improved nutrition. There are scattered resources across disease specific centers and Institutes in the government. Different agencies have missions, either overlapping or not, leaving gaps between them. That is a problem that we allude to in the report, and that is a problem that I’d like to ask a pointed question about. Those of you who are at NCI and those of you who are at CDC, is there a hole between these two agencies when it comes to getting the job done on tobacco control and nutrition?

Dr. Peter Greenwald: I don’t think there is a hole between the agencies. Some people say NCI does research, and CDC does applications, but I don’t feel that way. I feel that if NCI doesn’t do some applications for NIH, we don’t keep our eye on the ball, and if CDC doesn’t do some research, they are behind the times, so we both have to do both. But one does more of one than the other. The problem in nutrition is what you pointed out first; there is not a serious intensive effort where the resource allocation is anywhere near the level needed to address the obesity and physical activity problem. There is individual variability, there is a lot of interest in bioactive food compounds, and there are a lot of other things besides obesity and fitness that fall under nutrition. So, it is a matter of the scope of the effort that is not up to the scope of the problem.

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The Medical and Psychological Concerns of Cancer Survivors After Treatment

The medical and psychological effects of cancer and its treatment have been recognized for many years, but it is only recently that survivorship is coming to be recognized as a distinct phase of the cancer trajectory. Findings from research studies that have tracked the health and well-being of individuals long after cancer treatment has ended have identified risks that both the survivors and their health care providers should recognize. Advances in knowledge of how to manage conditions that arise in the post-treatment period have led to the development of some guidelines for health care providers to follow. The survivorship period provides many opportunities to improve the health and quality of life of cancer survivors. This chapter begins with a general overview of the potential medical and psychological consequences of cancer and its treatment. Brief descriptions are then provided on the late effects associated with four cancer types (breast, prostate, colorectal, and Hodgkin’s disease) as well as information on the need for services to ameliorate them. Lifestyle issues of interest to cancer survivors are reviewed—smoking cessation, physical activity, nutrition and diet, healthy weight, and the use of complementary and alternative medicine. The chapter concludes with a review of the committee’s findings and recommendations.

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To lose weight, it’s more important to walk for time than speed. Walking at a moderate pace yields longer workouts with less soreness - - leading to more miles and more calories spent on a regular basis.

High-intensity walks on alternate days help condition one’s system. But in a waking, weight-loss program, it’s better to be active every day. This doesn’t require walking an hour every day. The key is leading an active life-style 365 days a year.

When it comes to good health and weight loss, exercise and diet are interrelated. Exercising without maintaining a balanced diet is no more beneficial than dieting while remaining inactive.

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The Influence of Socio-economic Status in the Developing World on Nutrient Intake

2.7. Within any community, particularly one in the developing world, one also finds marked differences in intake reflecting socio-economic status. Figure 5 (see FIG. 5. Average Daily Energy and Nutrient Intake by Pregnant Ethiopian Women, Compared with FAO/WHO Recommendations (Source: refs. 6 and 31)) shows the average daily energy and nutrient intakes of pregnant Ethiopian women (6, 31). Unfortunately, there are no comparable quantitative data for lactation, but with the exception of the immediate post-natal period when, as Gebre-Medhin has described, special highly nutritious foods are provided, it is reasonable to conclude that the pattern of nutrients in the diet during most stages of lactation will be similar. It is readily apparent that the social differential for nutrients such as vitamin C and niacin (nicotinic acid) is substantially greater than for dietary energy. The data also serve to demonstrate important inter-country differences. In Ethiopia, in contrast to India and the Gambia, vitamin A and to a relative extent, riboflavin are in good supply. A further important difference occurs during lactation, when mothers are not only permitted but encouraged to drink a thick, nutritious traditional beer called tell. This has been shown to be a good source of folate and even B12 (31 ).

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Most individuals infected with the AIDS virus have no symptoms and feel well for a long time before eventually developing such symptoms as fever and night sweats, weight loss, swollen lymph glands in the neck, the underarms and groin area, sever fatigue or tiredness, diarrhea, white spots or unusual blemishes in the mouth. These symptoms are also symptoms of a number of other illnesses and that should be taken into consideration. Anyone with any of these symptoms for more than two weeks should not panic buy should consult their doctor.

The AIDS virus is not spread through normal daily contact at work, school or home. There have been no cases found where the virus has been transmitted by casual contact with AIDS patients in the home, workplace, or health care setting.

There is an antibody test that detects antibodies to the AIDS virus that causes the disease. The body produces antibodies that try to get rid of bacteria, viruses, or anything else that is not supposed to be in the bloodstream. The test may show if someone has been infected with the AIDS virus. While the testing procedure is considered accurate, it does not tell who will develop full-blown AIDS.

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If the swine flu outbreak became a pandemic, it would have a big impact on NHS services and our daily lives. The national framework includes making sure that the NHS is as prepared as it can be, and that treatment would reach people as soon as possible. It aims to protect the public by minimising disruption and the spread of the infection.

Antivirals

One of the ways to lessen the symptoms of pandemic flu is to treat infected people with antiviral medicines, which have been used against the current swine flu. The UK has stocks of these medicines and there is enough to treat up to half the population should they become ill during a pandemic, which is a reasonable worst-case scenario. However, the drugs must be administered at an early stage to be effective.

Testing has shown that the swine flu can be treated with the antiviral medicines oseltamavir (brand name Tamiflu) and zanamivir (Relenza).

Antivirals will help to:

• reduce the length of time you are ill by around one day
• relieve some of the symptoms
• reduce the potential for serious complications such as pneumonia

Antivirals will not cure you, but they lessen the symptoms and help you to recover.

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Traditional Chinese Medicine Recognized By The Chinese GovernmentAlthough almost all of the traditional Chinese anti-cancer medicine claims to be‍”a secret prescription handed down in the family from generation to generation”, theseries of “Tian Xian” medicine such as the Tian Xian Liquid and Tian Xian pill have‍undergone strict tests and research of its pharmacological action. With long-term clinicalexperiments done on a large scale and with approval from cancer patients, it has been‍nationally recognized as the traditional Chinese anti-cancer medicine.

Developed from Chinese medical and pharmaceutical theories, the series of Tianxian medicine falls into the category of “complex han prescription”. Specifically, the‍series of Tian Xian medicine abides by the theories of promoting the circulation of qi {atherapeutic method to relieve stagnation of qi by using medicines that regulate it};‍ promoting blood circulation by removing blood stasis (a method using blood-activatingand stasis-eliminating medicine); dissolving hard lumps, softening and dissolving hard‍masses (a therapy for the accumulation of phlegm and blood stasis); clearing away heatand toxic materials; eliminating dampness and removing phlegm; and removing necrotic‍tissues and promoting granulation (a method used to remove putrid tissues and promotegrowth of new tissues). The medicine pays special attention to the direct attack on cancer‍cells.

On the other hand, due to its direct attack on cancer cells as well as its effect onthe elimination of pathogenic factors, Tian Xian medicine also provides such functions as‍strengthening the spleen and stomach (improving and protecting the digestive system);invigorating the liver and reinforcing the kidney (supplementing the functions of both the‍liver and the kidneys and nourishing the liver too); restoring qi and enriching the blood;regulating yin and nourishing yang (for body balance), etc. In this manner, the original‍immunity of the body against cancer will be restored and the vital qi will be cultivated.

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If during the course of a cold you feel well rested and your flame is around catering, andyou are in the mood, why not? Threats of any kind would not be imposed on the‍establishment nor would it cause the human race any harm. Let the virus revel in triumph for aday or two. It may even be medically justified if the temptation endures and keeps interfering‍with your sleep.

In regard to your immediate family, insist on the exercise of the method even if theythink you are a lunatic. That’s what my wife thought I was at the be-ginning. If I force-dropped‍vitamin C solution in our child’s nose, it had to be done when she was not around. Herresponse to my confession always came with the accusation that my treatment of the child‍would shame a fiend.

But her anger always subsided after she saw the quick improvement of the child’scondition. Now she is a practitioner of the method herself. My ninety-one-year-old mother,‍with quick injections of vitamin C and gamma globulin shots became immune.

At the onset, I repeat, the VC wash gives you time till you reach someone who couldgive you the injections. For old people the VC wash is not mandatory if the wash, with its‍temporal discomfort, is too much for the old person.

When feeling not clean, by all means, take a bath. But not the type that would strainyou. Don’t sit in a hot tub for a half-hour. Don’t shower with very hot water so your body‍sweats afterward to get rid of the excess heat. That is strain.

Take a short shower with lukewarm water and shampoo you hair, too, if you have anelectric hair-dryer. Make your hair absolute dry after washing. Make sure your room is warm‍put on fresh, dry underwear and pajamas, go to bed, and cover your self to the chin. Put on ahome head wear of any kind if you have it, but take it off as soon as you feel your head is‍about to sweat.

Taking a shower as described makes your skin breathe and on the whole makesyou feel good. Taking a bath during a cold is good, provided you don’t go around doing‍house-chores.

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