Caffeine Plus Acetaminophen Toxic for Some

(HealthDay News) -- Very high doses of caffeine and acetaminophen (such as Tylenol), taken together, could lead to liver damage, researchers warn.

This combo produces a byproduct enzyme that's toxic to the organ, researchers from the University of Washington report.

This toxic twosome can occur not only by drinking caffeine while taking acetaminophen, the experts added, but also from large doses of painkillers that combine caffeine and acetaminophen. These painkillers are often used to treat migraines, menstrual discomfort and other conditions.

"Caffeine can interact with an enzyme that can form a toxic metabolite of acetaminophen in such a way that it increases the formation of that toxic metabolite," said lead researcher Sid Nelson, a professor of medicinal chemistry. "This can result in liver damage," he said.

In the study, Nelson's team tested the effects of acetaminophen and caffeine on E. coli bacteria.

These bacteria had been genetically engineered to mimic a human enzyme in the liver that detoxifies many prescription and nonprescription drugs, explained the authors in a report in the Oct. 15 issue of the journal Chemical Research in Toxicology.

Nelson noted that it takes large qualities of caffeine to produce this reaction.

"Normally people wouldn't be ingesting that amount of caffeine," he said. "It would take 10 times the amount of caffeine found in a couple of cups of coffee," Nelson said.

His team found that caffeine triples the amount of a toxin called N-acetyl-p-benzoquinone imine (NAPQI) produced by the enzyme as it breaks down acetaminophen.

This same toxin is also produced during an interaction between alcohol and acetaminophen that's also well known to damage the liver.

In prior studies, Nelson's team had found that high doses of caffeine boosted liver damage in rats that had already suffered acetaminophen-linked liver damage.

The bacteria used in the study were exposed to doses of acetaminophen and caffeine far higher than most people would be exposed to, Nelson noted. It's not clear at what point such a mixture becomes toxic, he said.

Some people may be more vulnerable to this toxic interaction than others, Nelson said. They might include people who take certain antiepileptic medications, such as carbamazepine and phenobarbital, and people who use the alternative remedy St. John's Wort.

These drugs increase levels of the enzyme that produces NAPQI and may produce even more when mixed with acetaminophen and caffeine together, Nelson speculated.

In addition, because alcohol can boost NAPQI production, people who drink a lot may be at increased risk for this toxic interaction, the researcher said. The risk is also increased for people who take drugs that combine acetaminophen and caffeine, used to treat migraines, arthritis and other conditions.

Still, for most people, there's no reason to panic, since the chances of caffeine and acetaminophen becoming a toxic mixture remains small, Nelson said.

"Almost all people don't need to worry about taking caffeine with acetaminophen," Nelson said. Exceptions might be, " those [people] taking high does of caffeine, high doses of acetaminophen, who are possibly alcoholic and/or are epileptic and take certain anticonvulsive drugs," he said.

More information
For more on acetaminophen, visit the U.S. National Library of Medicine.

Health Tip: Wash Fruits and Vegetables

(HealthDay News) - While it's important to eat plenty of fresh fruits and vegetables each day, it's also crucial to wash them before eating.

Here are some guidelines, courtesy of the University of Maine Cooperative Extension:

• Wash any raw fruit or vegetable before peeling, cutting, eating or cooking.
• Try a fruit and vegetable wash that is designed to remove bacteria and pesticides.
• Soak and wash produce in distilled water for one to two minutes.
• Use a vegetable brush to scrub any produce with a thick skin.
• Wash any produce that you grew yourself, or that was grown by someone else.
• Thoroughly wash your hands and any cutting or preparation surfaces before preparing fresh produce.

No Clear Winner in Diabetes Treatment Trial

(HealthDay News) -- A study designed to tell which insulin-plus-drug regimen might best control type 2 diabetes has produced disappointing preliminary results, with none of the three strategies tested coming out on top.

"What this shows is that none of the strategies in the study can be recommended" as being superior to the other, said Dr. Graham T. McMahon, an assistant professor of medicine at Brigham and Women's Hospital in Boston, and co-author of an editorial accompanying the report, published online Friday in the New England Journal of Medicine.

Instead, he said, the insulin regimen would probably have to be tailored to each patient, McMahon said.

The report was released early, because the preliminary, one-year results of the four-year study are being presented at a meeting of the European Association for the Study of Diabetes, in Amsterdam.

The study, led by British diabetes specialists at the University of Oxford, included 708 participants with type 2 diabetes. Type 2 diabetes, which affects about 95 percent of diabetics, typically occurs in adulthood and is often tied to obesity.

All of the trial participants were given maximum doses of two diabetes drugs, metformin and sulfonylurea, and a different regimen of injected insulin three times a day, two times a day or just once a day. The once-a-day group got an extra dose if deemed necessary.

The goal was to reduce blood levels of glycolated hemoglobin, which forms when sugar enters blood cells, to 6.5 percent or less.

The results overall were not impressive: The treatment goal was achieved by just 23.9 percent of those getting insulin three times a day, 17 percent of those getting insulin twice a day and 8.1 percent of those in the once-a-day group, the researchers reported.

The greater success rate in the two- and three-times-a-day regimen had a down side, the team noted, since it was also accompanied by an increased incidence of weight gain and low blood sugar levels, the report said.

Still, the results indicated that "the best thing to be done is to follow current guidelines," McMahon said. That means "using long-acting drugs and adding insulin either once, twice or three times a day," he said, depending on each patient's particular needs.

What the new data "suggests to the doctor is that if you are serious about controlling diabetes, you should be willing to use the more complex method," added Dr. Larry Deeb, clinical professor of pediatrics at the University of Florida and immediate past president of the American Diabetes Association.

Diabetes control "is hard work for doctor and patient," Deeb said, and "family doctors have got to learn to give insulin the way we endocrinologists do." Deeb is located in Tallahassee, Fla., where the ratio of endocrinologists is 1 to 75,000 inhabitants, he noted.

Family doctors can handle type 2 diabetes, McMahon said, but it is best if they do not work alone. "An endocrinologist, nutritionist and nurse-educator should cooperate," he said.

Because type 2 diabetes is a major risk factor for heart disease, attention should be paid not only to blood sugar levels but also to other coronary risk factors, such as blood pressure and cholesterol levels, McMahon said.

What lies ahead for the British study is uncertain, McMahon said. "They are going to next look at what happens when the first steps fail," he said.

More information
For more on type 2 diabetes, consult the American Diabetes Association.

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Nasal Flu Vaccine Approved for Children Ages 2-5

(HealthDay News) -- The nasal flu vaccine FluMist has been approved by the U.S. Food and Drug Administration for children between the ages of two and five.

Previously, the vaccine's approval had been limited to healthy people ages five to 49. It's made from a weakened form of the live influenza virus; in contrast flu shots usually contain a dead form of the virus.

The U.S. Centers for Disease Control and Prevention suggests that children six months and older be vaccinated for flu. However, the FDA said children under two years should not get FluMist because of an increased risk of wheezing and other side effects of the nasal inoculation.

FluMist also shouldn't be given to anyone with asthma, those with allergies to eggs, or to children under age five who chronically wheeze, the agency said.

FluMist is produced by MedImmune Vaccines Inc.

More information
Here's more about the expanded FluMist approval from the FDA.

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Don't Ignore Tough or Long-Term Stomach Pain

(HealthDay News) -- While the occasional stomachache isn't a serious health issue, persistent or severe stomach pain is another matter that could signal serious trouble, says the American College of Gastroenterology (ACG).
People with the following symptoms need to see a doctor:

• steady, severe pain or regularly recurring pain;


• pain lasting for hours or days;


• pain that wakes you from sleep;


• pain that impairs your ability to work or perform routine activities;


• loss of weight or appetite.

Immediate medical attention is required if abdominal pain is accompanied by:

• fever;


• diarrhea;


• persistent constipation;


• blood in the stool;


• change in the color of urine;


• persistent nausea or vomiting;


• vomiting blood;


• severe tenderness of the belly;


• jaundice (yellowish discoloration of the skin or whites of the eyes);


• swelling of the abdomen.

The ACG also recommends that people see a doctor if they are regularly taking any medicines that can cause ulcers, such as aspirin or other medications commonly used to treat arthritis or headaches.

More information
The MedlinePlus Medical Encyclopedia has more about abdominal pain.

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Contact Lens Germs Give Clues to Eye Infection

(HealthDay News) -- Cultures made from organisms found on contact lenses may help identify the causes of corneal eye infection (microbial keratitis), Australian researchers report.

Reporting in the September issue of the journal Archives of Ophthalmology, researchers at the University of Melbourne reviewed the records of 49 patients (average age 34) with contact lens-related microbial keratitis. There were a total of 50 affected eyes.

Organisms were found to be growing on 17 (34 percent) corneal scrapings and 35 contact lenses (70 percent). In 13 eyes, identical organisms were growing in the cultures taken from the corneal scrapings and from the contact lenses. In two eyes, different organisms were found in the corneal eye scrapings and in the contact lenses.

Serratia marcescens was the most common organism found in both the corneal scrapings and the contact lenses, the researchers said.

"Contact lens culture may help in the identification of the causative organism in many cases of contact lens-related microbial keratitis," the study authors concluded. Culture findings may also "help in choosing the appropriate microbial agent" to fight the patient's infection, the researchers added.

More information
The U.S. Food and Drug Administration outlines the risks associated with contact lenses.

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1 in 3 Varsity Athletes Has Exercise-Induced Asthma

(HealthDay News) -- One out of three college athletes have what's known as exercise-induced asthma, even though they may have no prior history of the illness, a new study shows.

Previous research in Olympic athletes has also shown high rates of exercise-induced asthma.

"We targeted varsity athletes in this study, because many of the reported severe episodes of asthma provoked by exercise have occurred among competitive athletes under the age of 21," Dr. Jonathan Parsons, associate director of the Ohio State University Medical Center's Asthma Center, said in a prepared statement. "Now that we've demonstrated how common this problem can be, more research is needed to determine the best way to monitor and manage athletes at the highest risk of developing symptoms while participating in their sports."

Exercise-induced asthma typically occurs between 5 minutes and 20 minutes after intense physical exertion. Symptoms include wheezing, chest tightness, coughing, shortness of breath and chest pain, according to the American Academy of Allergy, Asthma & Immunology.

While 7 percent of Americans are known to suffer from asthma, many others, including people with allergies or a family history of allergies, may experience asthma after exercise.

Approximately one in 10 people with no history of asthma can experience exercise-induced asthma.

Parsons' team tested 107 varsity athletes for exercise-induced asthma. Out of that group, 42 (39 percent) were positive. The majority of the athletes who tested positive had no prior history of asthma. The data also showed that gender and the breathing demands of the athlete's preferred sport did not affect the likelihood of testing positive.

The researchers tested for asthma using "eucapnic voluntary hyperpnea testing." This is a technique that mimics the expected changes in exercise-induced asthma by making a person hyperventilate and then measuring their lung function. According to the researchers, this is the first study to use this method in varsity athletes.

Writing in the September issue of Medicine & Science in Sports & Exercise, the researchers called for the development of routine asthma diagnosis and management among athletes.

According to the researchers, the symptoms of exercise-induced asthma varied widely in the group of athletes they studied, demonstrating the difficulty of diagnosing the condition.

"One important finding of this study is that a history of symptoms with exercise is not enough to make a correct diagnosis," said Parsons. "Diagnosis and treatment of exercise-induced asthma based solely upon subjective symptoms could increase the number of inaccurate diagnoses and expose people to unnecessary medications."

More information
To learn more about exercise-induced Asthma, visit the American Academy of Allergy, Asthma & Immunology.

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Health Tip: Preventing a Bunion

(HealthDay News) -- A bunion is a sore, swollen bump on the foot at the joint of the big toe. It can be very sore and painful, and may require surgery to remove.
Here are suggestions to prevent a bunion, courtesy of the American Academy of Orthopaedic Surgeons:

• Never try to force your foot into a shoe that doesn't fit well, or is too tight.
• Wear soft-soled shoes with wide insteps and ample space for the toes.
• Don't wear any heels higher than 2 1/4 inches.
• Avoid pointy-toed shoes.
• Wear cushioned pads in your shoes to prevent a bunion, and also to ease the pain of a bunion that has already formed.

Nasal Anthrax Vaccine Proves Effective in Animal Study

(HealthDay News) -- An experimental nasal anthrax vaccine proved highly effective in tests in mice and guinea pigs, a University of Michigan Medical School study shows.

After it was placed inside the animals' noses, the vaccine triggered a strong immune response. All immunized guinea pigs survived after they received injections of 1,000 times the lethal dose of anthrax spores. All unprotected guinea pigs died.

From 40 percent to 70 percent of immunized animals survived after large doses of anthrax spores were placed directly in their nasal tissue.

In these animal experiments, there have been no significant side effects, and the vaccine has produced effective immunity for at least six months, the study said.

The nasal vaccine features tiny soybean oil droplets that are small enough to carry an anthrax protein inside the nasal membrane. Immune system cells then react to the anthrax protein and prime the entire immune system to attack anthrax.

This nasal vaccine is easier and more effective than the current injectable vaccine, according to the researchers. The nasal vaccine is also easier to store and use in locations where there is no available refrigeration.

The next step is to test whether the vaccine produces immunity in primates. The researchers are also preparing plans for safety studies in humans.

The study was published in the August issue of Infection and Immunity.

More information
The U.S. Centers for Disease Control and Prevention has more about anthrax.