"Diabulimia" in Type 1 Diabetes

According to the National Eating Disorders Association, eating disorders — such as anorexia, bulimia and binge eating disorder — include extreme emotions, attitudes and behaviors surrounding weight and food issues. Eating disorders are serious emotional and physical problems that can have life-threatening consequences for females and males.

Women with type 1 diabetes are more than twice as likely to develop an eating disorder than age-matched women without diabetes.

Eating disorders in type 1 diabetes such as "diabulimia," as it is known in the popular press, represent some of the most complex patient problems—both medically and psychologically.
Women with eating disorders and diabetes typically struggle with symptoms similar to those of women with eating disorders who do not have diabetes.  However, they exhibit a very dangerous symptom of calorie purging in the form of insulin restriction.
This condition is characterized by weight and body image concerns that lead to the mismanagement of diabetes.

The NHS National Diabetes Audit says a high proportion of women aged between 15 and 30 are skipping insulin injections to lose weight. Now a charity wants diabulimia, as it is known, officially recognised as a mental health condition.

"Between 1 April 2010 and 31 March 2011, 8,472 people included in the NDA [national diabetes audit] were admitted to hospital in the UK for diabetic ketoacidosis."

Recognize eating disorders in diabetes

Warning signs may include:

• unexplained elevations in A1C values
• repeated problems with diabetic ketoacidosis (DKA), which can be fatal
• extreme concerns about weight and body shape
• change in eating patterns
• unusual patterns of intense exercise (sometimes associated with frequent hypoglycemia)
• amenorrhea (skipping monthly menstrual periods)

Understand the medical risks associated with eating disorders and diabetes

• higher A1C levels
• higher risk of developing infections
• more frequent episodes of DKA
• more frequent hospital and emergency room visits 
• higher rates and earlier onset of diabetes complications - nerve damage, eye disease, kidney disease and possible heart disease

Resources:
http://www.mayoclinic.com/health/diabulimia/MY01793
http://www.bbc.co.uk/newsbeat/20988655
http://www.medicinenet.com/script/main/art.asp?articlekey=81960

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Benefits of Running

Believe it or not, running is really a great way to increase your overall level of health. Research shows that running can lift your levels of good cholesterol while also helping you increase lung function and use. In addition, running can as well boost your immune system and lower your risk of developing blood clots.

For women, running can really help to lower your risk of breast cancer. It can also help reduce the risk of having a stroke. Many doctors today recommend running for people who are in the early stages of diabetes, high blood pressure, and osteoporosis, and it is proven to help reduce the risk of having a heart attack. By helping the arteries retain their elasticity and strengthening the heart, your chances of suffering a heart attack can be significantly reduced.

Running is one of the best forms of exercise for losing or maintain a consistent weight. You will find that it is a leading way to burn off extra calories and that it is the second mainly effective exercise in terms of calories burned per minute, next only after cross country skiing. Not all of the benefits of running are physical. Running can provide an noticeable boost to your self-confidence and self-esteem. By setting and achieving goals, you can help give yourself a superior sense of empowerment that will leave you feeling much happier.

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November 2011- Health Observations and Events

Awareness Event	Coverage	Related Organization
Muscular Dystrophy Awareness Month	Australia	Muscular Dystrophy Australia
Crohn's and Colitis Awareness Month	Canada	Crohn's & Colitis Foundation of Canada
Amaryllis Month	Canada	Huntington Society of Canada
Cardio Pulmonary Resuscitation Awareness (CPR) Month	Canada	Heart and Stroke Foundation of Canada
Diabetes Awareness Month	Canada	Canadian Diabetes Association
Hemophilia Awareness Month	Canada	Canadian Hemophilla Society
Osteoporosis Month	Canada	Osteoporosis Canada
National Marrow Awareness Month	United States	National Marrow Donor Program
National Hospice Month	United States	The National Hospice and Palliative Care Organization
Diabetic Eye Disease Month	United States	Prevent Blindness America
National Healthy Skin Month	United States	American Academy of Dermatology
Prematurity Awareness Month	United States	March of Dimes
National Epilepsy Month	United States	Epilepsy Foundation
American Diabetes Month	United States	American Diabetes Association
Pancreatic Cancer Awareness Month	United States	Pancreatic Cancer Action Network
National Alzheimer's Disease Awareness Month	United States	Alzheimer's Association
Pulmonary Hypertension Awareness Month	United States	Pulmonary Hypertension Association
Lung Cancer Awareness Month	Worldwide	Macmillan Cancer Support

November 2011 Health Current Events - Weeks

Event	Date	Nation	Organisation
Scleroderma Awareness Week	3rd Nov - 9th Nov	United Kingdom	Raynauds & Scleroderma Association
Mouth Cancer Awareness Week	11th Nov - 17th Nov	United Kingdom	Mouth Cancer
GERD Awareness Week	18th Nov - 24th Nov	Worldwide	IFFGD
Diabetes Awareness Week	18th Nov - 24th Nov	New Zealand	Diabetes New Zealand

November 2011 Health Events - Days

Event	Date	Nation	Organization
World Diabetes Day	14th Nov	Worldwide	World Diabetes Day
Great American Smokeout Day	20th Nov	United States	American Cancer Society

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The Benefits of Flax Seeds

Flax (also known as common flax or linseed) (binomial name: Linum usitatissimum)  is native to the region extending from the eastern Mediterranean to India and was extensively cultivated in ancient Ethiopia and ancient Egypt.
Some call it one of the most powerful plant foods on the planet. There’s some evidence it may help reduce your risk of heart disease, cancer, stroke, and diabetes. 

Uses

Flax is grown both for its seeds and for its fibers. Various parts of the plant have been used to make fabric, dye, paper, medicines, fishing nets, hair gels, and soap. Flax seed is the source of linseed oil, which has uses as an edible oil, as a nutritional supplement and as an ingredient in many wood finishing products. It is also grown as an ornamental plant in gardens.

Flax seed

Flax seeds come in two basic varieties: (1) brown; and (2) yellow or golden. Most types have similar nutritional characteristics and equal amounts of short-chain omega-3 fatty acids. The exception is a type of yellow flax called solin (trade name Linola), which has a completely different oil profile and is very low in omega-3 FAs. Although brown flax can be consumed as readily as yellow, and has been for thousands of years, it is better known as an ingredient in paints, fiber and cattle feed. Flax seeds produce a vegetable oil known as flaxseed or linseed oil, which is one of the oldest commercial oils, and solvent-processed flax seed oil has been used for centuries as a drying oil in painting and varnishing.


What's It Made Of

Flaxseed contains several phyto (plant) compounds that may be beneficial in humans, including:

• Fiber (including soluble and insoluble)
• Protein -- approximately 20%
• Lignans
• Essential fatty acids (ALA) -- flaxseed is approximately 35% oil, of which 55% is ALA.

The laxative effect of flaxseed is due to its fiber and mucilage content. As described earlier, phytoestrogens, known as lignans, appear to play a role in the cancer protective effects of this plant. Other health benefits of flaxseed (such as protection from heart disease and arthritis) are likely due to its high concentration of the omega-3 fatty acid ALA.

Health Benefits

Flaxseeds are rich in alpha linolenic acid (ALA), an omega-3 fat that is a precursor to the form of omega-3 found in fish oils called eicosapentaenoic acid or EPA. Since the fats are found in their isolated form in flaxseed oil, it is a more concentrated source of ALA than the seeds themselves (although it doesn't have the other nutrients that the seeds do). ALA, in addition to providing several beneficial effects of its own, can be converted in the body to EPA, thus providing EPA's beneficial effects. For this conversion to readily take place, however, depends on the presence and activity of an enzyme called delta-6-destaurase, which, in some individuals, is less available or less active than in others. In addition, delta-6-desaturase function is inhibited in diabetes and by the consumption of saturated fat and alcohol. For these reasons, higher amounts of ALA-rich flaxseeds or its oil must be consumed to provide the same benefits as the omega-3 fats found in the oil of cold-water fish.

Yet research indicates that for those who do not eat fish or wish to take fish oil supplements, flaxseed oil does provide a good alternative. A study published in the Journal of Nutrition found that flaxseed oil capsules providing 3 grams of alpha-linolenic acid daily for 12 weeks—an amount that would be provided by 3 tablespoons of flaxseed oil a day—increased blood levels of EPA by 60% in a predominantly African-American population with chronic illness.

A recent MedLine check (MedLine provides access to the published peer-reviewed medical literature) revealed 1,677 research articles on linolenic acid, investigating its effects on numerous physiological processes and health conditions.

Cancer
Recent studies have suggested that flaxseed may have a protective effect against cancer, particularly breast cancer, prostate cancer, and colon cancer. At least two of the components in flaxseed seem to contribute, says Kelley C. Fitzpatrick, MSc, director of health and nutrition with the Flax Council of Canada.
In animal studies, the plant omega-3 fatty acid found in flaxseed, called ALA, inhibited tumor incidence and growth.
Further, the lignans in flaxseed may provide some protection against cancers that are sensitive to hormones without interfering with the breast cancer drug tamoxifen. Some studies have suggested that exposure to lignans during adolescence helps reduce the risk of breast cancer and may also increase the survival of breast cancer patients, Thompson says.
Lignans may help protect against cancer by:

• Blocking enzymes that are involved in hormone metabolism.
• Interfering with the growth and spread of tumor cells.

Some of the other components in flaxseed also have antioxidant properties, which may contribute to protection against cancer and heart disease.

Cardiovascular Disease
Research suggests that plant omega-3s help the cardiovascular system via several different mechanisms, including anti-inflammatory action and normalizing the heartbeat, Fitzpatrick says. New research also suggests significant blood pressure-lowering effects of flaxseed, which may be due to both the omega-3 fatty acids as well as the amino acid groups found in flaxseed.
Several studies have suggested that diets rich in flaxseed omega-3s help prevent hardening of the arteries and keep plaque from being deposited in the arteries, partly by keeping white blood cells from sticking to the blood vessels’ inner linings.
"Lignans in flaxseed have been shown to reduce atherosclerotic plaque buildup by up to 75%," Fitzpatrick says.
Because plant omega-3s may also play a role in maintaining the heart’s natural rhythm, they may be useful in treating arrhythmia (irregular heartbeat) and heart failure, although more research is needed on this.
Eating flaxseed daily may help your cholesterol levels, too. Small particles of LDL or "bad" cholesterol in the bloodstream have been linked to an increased risk of heart disease, obesity, diabetes, and metabolic syndrome. A French-Canadian study in menopausal women reported a decrease in these small LDL particles after the women ate 4 tablespoons of ground flaxseed daily for a year. Fitzpatrick says the cholesterol-lowering effects of flaxseed are the result of the synergistic benefits of the omega-3 ALA, fiber, and lignans.

High cholesterol

People who follow a Mediterranean diet tend to have higher HDL ("good") cholesterol levels. The Mediterranean diet consists of a healthy balance between omega-3, omega-6, and omega-9 (found in olive oil) fatty acids. It emphasizes whole grains, root and green vegetables, daily intake of fruit, fish and poultry, olive and canola oils, and ALA (from flaxseed, flaxseed oil, and walnuts), along with discouragement of ingestion of red meat and not much use of butter and cream.

Flaxseed and flaxseed oil have been reported to possess cholesterol-lowering properties in laboratory studies. Human studies have used flaxseed products and measured effects on cholesterol, with mixed results. A human study found that dietary flaxseed significantly improved lipid (cholesterol) profile in patients with high cholesterol, and may favorably modify cardiovascular risk factors.

Diabetes

Preliminary research also suggests that daily intake of the lignans in flaxseed may modestly improve blood sugar (as measured by hemoglobin A1c blood tests in adults with Type 2 Diabetes).

Inflammation
Two components in flaxseed, ALA and lignans, may reduce the inflammation that accompanies certain illnesses (such as Parkinson's disease and asthma) by helping to block the release of certain pro-inflammatory agents, Fitzpatrick says.
The plant omega-3 ALA has been shown to decrease inflammatory reactions in humans. And studies in animals have found that lignans can decrease levels of several pro-inflammatory agents.
Reducing inflammatory reactions associated with plaque buildup in the arteries may be another way flaxseed helps prevent heart attack and strokes.

Hot Flashes
One preliminary study on menopausal women, published in 2007, reported that 2 tablespoons of ground flaxseed mixed into cereal, juice, or yogurt twice a day cut the women's hot flashes in half. And the intensity of their hot flashes dropped by 57%. The women noticed a difference after taking the daily flaxseed for just one week, and achieved the maximum benefit within two weeks.
But at the 2011 meeting of the American Society of Clinical Oncology, Mayo Clinic researchers reported there was no significant reduction in hot flashes between postmenopausal women and breast cancer patients eating a bar containing 410 milligrams of phytoestrogens from ground flaxseed and the group eating a placebo bar.

Omega-3-rich Flaxseeds Protect Bone Health

Alpha linolenic acid, the omega-3 fat found in flaxseed and walnuts, promotes bone health by helping to prevent excessive bone turnover—when consumption of foods rich in this omega-3 fat results in a lower ratio of omega-6 to omega-3 fats in the diet.(Griel AE, Kris-Etherton PM, et al. Nutrition Journal)
Other studies have shown that diets rich in the omega-3s from fish (DHA and EPA), which also naturally result in a lowered ratio of omega-6 to omega-3 fats, reduce bone loss. Researchers think this is most likely because omega-6 fats are converted into pro-inflammatory prostaglandins, while omega-3 fats are metabolized into anti-inflammatory prostaglandins. (Prostaglandins are hormone-like substances made in our bodies from fatty acids.)
In this study, 23 participants ate each of 3 diets for a 6-week period with a 3 week washout period in between diets. All 3 diets provided a similar amount of fat, but their ratio of omega-6 to omega-3 fats was quite different:
Diet 1 provided 34% total fat with omega-6 and omega-3 fats in amounts typically seen in the American diet: 9% polyunsaturated fats (PUFAs) of which 7.7% were omega-6 and only 0.8% omega-3 fats, resulting in a pro-inflammatory ratio of 9.6:1.
Diet 2, an omega-6-rich diet, provided 37% total fat containing 16% PUFAs of which 12% were omega-6 and 3.6% omega-3, a better but still pro-inflammatory ratio of 3.3:1.
Diet 3, which provided 38% in total fats, was an omega-3-rich diet, containing 17% PUFAs, of which 10.5% were omega-6 and 6.5% omega-3, resulting in an anti-inflammatory ratio of 1.6:1.
After each diet, subjects' blood levels of N-telopeptides, a marker of bone breakdown, were measured, and were found to be much lower following Diet 3, the omega-3-rich diet, than either of the other two.
The level of N-telopeptides seen in subjects' blood each diet also correlated with that of a marker of inflammation called tumor necrosis factor-alpha (TNF-alpha). Diets 1 and 2—the diets which had a significantly higher ratio of omega-6 to omega-3 fats—also had much higher levels of TNF-alpha than the Diet 3, which was high in omega-3 fats from walnuts and flaxseed. Practical Tip: Protect your bones' by making anti-inflammatory omega-3-rich flaxseed and walnuts, as well as cold water fish, frequent contributors to your healthy way of eating.

Other uses

Although further research is needed, preliminary evidence suggests that omega-3 fatty acids may help protect against certain infections and treating a variety of conditions, including ulcers, migraine headaches, attention deficit/hyperactivity disorder, addiction, eating disorders, preterm labor, emphysema, psoriasis, glaucoma, Lyme disease, lupus, and panic attacks.

Available Forms:

Flaxseed oil should be refrigerated. Use whole flaxseeds within 24 hours of grinding, otherwise the ingredients lose their activity. Flaxseeds are also available ground in a special mylar package so that the components in the flaxseeds stay active. Ripe seeds, linseed cakes, powder, capsules, and flaxseed oil are all available at health food and grocery stores.

How to Take It

Pediatric

Flaxseed oil may be added to a child's diet to help balance fatty acids. If an infant is breastfed, the mother may ingest oil or fresh ground seed to increase fat content in breast milk. See adult dosage below.

Children (2 - 12 years): 1 teaspoonful (tsp) daily of ground flaxseeds, or 1 tsp of fresh flaxseed oil for constipation.

Adult

Flaxseed: Take 1 tablespoonful (tbsp), 2 - 3 times daily or 2 - 4 tbsp, 1 time daily. Grind before eating and take with lots of water.

Flaxseed oil: Take 1 - 2 tablespoonfuls daily, or 1 - 2 capsules daily. Flaxseed oil is often used in a liquid form, which contains approximately 7 g of ALA per 15 mL tbsp, and contains approximately 130 calories.

As a substitute for fish oil, a dose of 7.2 grams of flaxseed is approximately equivalent to 1 gram of fish oil.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

• Although studies have found that regular consumption of fish (which includes the omega-3 fatty acids EPA and DHA) may reduce the risk of macular degeneration, a recent study including two large groups of men and women found that diets rich in ALA may increase the risk of this disease. Ask your health care provider.
• Flaxseed may slow down the absorption of oral medications or other nutrients if taken at the same time. Therefore, flaxseed should be ingested several hours before, or after medicines or supplements. Talk to your health care provider before taking flaxseed if you regularly take any prescription or nonprescription medications, or dietary supplements.
• People with either diabetes or schizophrenia may lack the ability to convert ALA to EPA and DHA, the forms of omega-3 fatty acids that are generally made from ALA and are more readily used by the body. Therefore, people with these conditions should obtain their omega-3 fatty acids directly from dietary sources rich in EPA and DHA, such as cold water fish (including mackerel, salmon, or whitefish).
• Do not use flaxseed products or ALA if you have diabetes, prostate problems, breast cancer, or schizophrenia without the advice and supervision of a qualified health care provider.

Possible Interactions

Flaxseed supplements may alter the effects of some prescription and nonprescription medications. If you are currently being treated with any of the following medications, you should not use flaxseed without first talking to your health care provider:

Blood-Thinning Medications -- Omega-3 fatty acids may increase the effects of blood-thinning medications, including aspirin and warfarin. While the combination of aspirin and omega-3 fatty acids may be helpful under certain circumstances (such as heart disease), they should only be taken together under the guidance and supervision of a qualified health care provider.

Diabetic Medications -- If you are taking medicines for diabetes, including insulin, you should only use flaxseed (ALA) under the supervision of a qualified health care provider.

Oral Contraceptives or Hormonal replacement therapy (HRT) -- Flaxseed may alter hormonal levels and alter the effects of oral contraceptives or HRT. Only use flaxseed under the supervision of a qualified health care provider if you are taking hormonal altering medications such as oral contraceptives or HRT.

Other -- Avoid taking flaxseed at the same time of day as medications and other supplements, as it may slow down the absorption of oral medications or other nutrients if taken at the same time. Take the flaxseed either 1 hour before or 2 hours after taking any prescription or nonprescription medicine or dietary supplement.

Sources:
Does ground flaxseed have more health benefits than whole flaxseed? http://www.mayoclinic.com/health/flaxseed/AN01258
Case: This Single Food Helps Your Cholesterol, Heart, and Weight
The Benefits of Flaxseed http://www.webmd.com/diet/features/benefits-of-flaxseed?page=3

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New Clues to How Gastric Bypass Surgery Combats Diabetes

Gastric bypass surgery has been known to improve blood sugar control, often sending people with type 2 diabetes into remission, but experts have long wondered exactly how that happens. Now, a new study provides some clues. Circulating amino acids linked with insulin resistance decline dramatically in those who have the bypass surgery, the researchers discovered. They compared 10 obese people with diabetes who had the surgery with 11 who lost weight through dieting. "Something happens after gastric bypass that does not happen as much after the diet-induced weight loss," said Dr. Blandine Laferrere, an associate professor of medicine at St. Luke's Roosevelt Hospital Center and Columbia University, both in New York City.

The surgery, which reduces the stomach to the size of a small pouch, also modifies the junction between the stomach and small intestine. It leads to a dramatic reduction in the level of circulating amino acids that have been linked with diabetes. "The fact that gastric bypass results in the remission of diabetes in the majority of patients is not new," said Laferrere. According to background information in the study, 50 percent to 80 percent of diabetes cases go into remission after the surgery. What doctors have been trying to figure out, she said, is why the bypass surgery is so good at making the diabetes disappear. "The diabetes improves almost immediately, before a significant amount of weight loss occurs," she said. "That points out it is something other than the weight loss."

In the new study, the researchers evaluated biochemical compounds involved in metabolic reactions in the participants. Each group had lost about 20 pounds. The investigators found that the bypass patients had much lower levels of amino acids known as branched-chain amino acids, and the amino acids phenylalanine and tyrosine. "Those changes in the amino acids could be implicated in the mechanism of diabetes remission after gastric bypass," Laferrere said. Experts know the amino acids are linked with insulin resistance partly due to animal studies, she said. "If you supplement the diet of rats with branched-chain amino acids, you can induce more insulin resistance," she explained.

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Do Immune System Ills Help Drive Type 2 Diabetes?

New research suggests that the development of insulin resistance and type 2 diabetes may be linked to an immune system reaction gone awry. "The main point of this study is trying to shift the emphasis in thinking of type 2 diabetes as a purely metabolic disease, and instead emphasize the role of the immune system in type 2," said study co-author Dr. Daniel Winer, an endocrine pathologist at Toronto General Hospital in Canada. When the research began, Winer was a postdoctoral fellow at Stanford University in California. The researchers have identified immune system antibodies in people who are obese and insulin-resistant that aren't present in people who are obese without insulin resistance. They also tested a drug that modifies the immune system in mice fed a fatty diet, and found that the medication could help maintain normal blood sugar levels.

The findings were published online April 17 in the journal Nature Medicine. Funding for the study was provided by the U.S. National Institutes of Health. Nearly 26 million Americans have diabetes, according to the U.S. Centers for Disease Control and Prevention. Between 90 percent and 95 percent of these cases are type 2 diabetes, where the body doesn't use insulin efficiently, so the pancreas must make increasing amounts of insulin. Eventually, the pancreas stops making enough insulin to meet the increased demand. The less common form of the disease, type 1 diabetes, occurs when the immune system mistakenly destroys the insulin-producing beta cells in the pancreas. This type of diabetes is considered an autoimmune disease, and isn't linked to how much a person weighs.

Although the causes of type 2 haven't been clear, it's known that the disease runs in families, suggesting a genetic component. Also, while type 2 is strongly linked to increased weight, not everyone who is overweight gets type 2 diabetes. And, that's what got the researchers searching for another factor. Winer explained that excess weight has been linked to inflammation, which can cause the immune system to react. As visceral fat (abdominal fat) expands, it eventually runs out of room, explained Winer. At that point, the fat cells may become stressed and inflamed, and eventually the cells die. When that happens, immune system cells known as macrophages come to sweep up the mess.

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Stroke Hospitalizations Up in Teens, Young Adults

Older Americans are suffering fewer strokes, but new government research shows that stroke hospitalizations are sharply rising among children and younger adults, especially for men under 35. Although the study doesn't explore the reasons for the trend, experts point to the obesity epidemic, increasing rates of diabetes and high blood pressure as likely culprits. Recreational drugs may play a role as well, they added. "Young people should see their doctor for regular checkups," said Dr. Brett Kissela, a professor of neurology at the University of Cincinnati Neuroscience Institute, who has conducted previous research on strokes but was not involved with this study.

Routine check-ups can help control risk factors for stroke, such as high blood pressure, he explained. Dr. Mary George, a researcher with the U.S. Centers for Disease Control and Prevention, is scheduled to report the findings Wednesday at the International Stroke Conference in Los Angeles. Experts note that research presented at meetings typically has not been subjected to the same scrutiny as studies published in peer-reviewed medical journals. For the study, CDC researchers examined hospitalization data for the period from 1994 to 2007 from the Nationwide Inpatient Sample, identifying patients with a primary diagnosis of ischemic stroke.

Ischemic stroke, which occurs when a blood clot or clogged artery blocks the blood supply to the brain, is more common than hemorrhagic stroke, the result of a ruptured blood vessel. The increases and decreases in stroke rates varied by gender and age group, the researchers found. Among males aged 15 to 34, the rate surged by nearly 53 percent. Among females in that age group, it increased 17 percent. Strokes soared 36 percent in boys aged 5 to 14 and 31 percent in girls of the same age. Men between 35 and 44 years old had a 47 percent increase in stroke incidence. For women in that age range, stroke incidence rose 36 percent.

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Maggot Therapy In Unhealing Wounds

Maggot Debridement Therapy (MDT) is the medical use of live maggots (fly larvae) for treating non-healing wounds.

In maggot debridement therapy (also known as maggot therapy, larva therapy, larval therapy, biodebridement or biosurgery), disinfected fly larvae are applied to the wound for 2 or 3 days within special dressings to keep them from migrating. The literature identifies three primary actions of medical grade maggots on wounds:

1. They clean the wounds by dissolving dead and infected tissue ("debridement");
2. They disinfect the wound (kill bacteria);
3. They speed the rate of healing
   
   !! The video might be disturbing for some of you
   
   
   
   
   History of Maggot Therapy

      Maggots have been known for centuries to help heal wounds. Military surgeons noted that soldiers whose wounds became infested with maggots had better outcomes than those not infested. William Baer, while at Johns Hopkins University in Baltimore, Maryland, may have been the first in the Northern Hemisphere to have intentionally applied larvae to wounds in order to induce wound healing. During the late 1920's, he identified specific species, raised them in the laboratory, and used their larvae to treat several children with osteomyelitis and soft tissue infections. He presented his findings at a surgical conference in 1929. Two years later, after treating 98 children, his findings were published posthumously.

The first modern clinical studies of maggot therapy were initiated in 1989, at the Veterans Affairs Medical Center in Long Beach, CA, and at the University of California, Irvine, to answer the following questions:

1. "Is maggot therapy still useful today?"
2. "Should maggot therapy be used as an adjunct to other treatments, not merely as a last resort?"
3. "How does maggot therapy compare to other treatments at our disposal?" 
   
          The results of those controlled comparative clinical trials and the many studies and reports that followed, indicate that MDT is still useful today as a safe and effective treatment tool for some types of wounds. Those studies also demonstrated that there is no reason to withhold MDT until all other modalities have been exhausted, nor use it only as a “last resort.” Indeed, while published accounts of “pre-amputation MDT” show a limb salvage rate of over 40%, the success of MDT when used earlier in the course of treatment (say, as a 2nd or 3rd or 4th line treatment) is even more dramatic.

Current status of maggot therapy

In 1995, a handful of doctors in 4 countries were using MDT. Today, any physician in the U.S. can prescribe maggot therapy. Over 4,000 therapists are using maggot therapy in 20 countries. Approximately 50,000 treatments were applied to wounds in the year 2006.

In January 2004, the U.S. Food and Drug Administration (FDA) began regulating medicinal maggots, and allowed the production and marketing of one particular strain of Phaenicia sericata larvae marketed under the brand name Medical Maggots (TM). In February, 2004, the British National Health Service (NHS) permitted its doctors to prescribe maggot therapy. Patients no longer have to be referred to one of a few regional wound-specialty hospitals to get maggot treatments.

The BioTherapeutics, Education & Research Foundation was established in 2003 for the purpose of supporting patient care, education, and research in maggot therapy and the other forms of symbiotic medicine (diagnosing and/or treating diseases with live animals, such as maggot therapy, leech therapy, honey bee therapy, pet therapy; sniffer dogs, ichthiotherapy, bacteriotherapy etc).

Biology of flies and maggots

Maggots are fly larvae, or immature flies, just as caterpillars are butterfly or moth larvae. Maggots do not appear all by themselves ("de novo"), as was believed 150 years ago; they hatch from eggs, laid by adult female flies.

Not all species of flies are safe and effective as medicinal maggots. There are thousands of species of flies, each with its own habits and life cycle. Some fly larvae feed on plants or animals, or even blood (i.e., mosquitoes). Others feed on rotting organic material.

Those flies whose larvae feed on dead animals will sometimes lay their eggs on the dead parts (necrotic or gangrenous tissue) of living animals. When maggots are infesting live animals, that condition is called “myiasis.” Some of those maggots will feed only on dead tissue, some only on live tissue, and some on live or dead tissue. The flies used most often for the purpose of maggot therapy are "blow flies" (Calliphoridae); and the species used most commonly is Phaenicia sericata, the green blow fly.

A diagram and photograph of a typical blow fly life cycle appears below (used with permission of the BTER Foundation)

Advantages and disadvantages of maggot debridement therapy (“MDT")

• Efficacy, as demonstrated in several small but significant controlled clinical studies.
• Takes about 15-30 minutes to apply a secure dressing to keep the maggots in place.
• Excellent safety record.
• Maggots are highly perishable and should be used within 24 hours of arrival.
• Simple enough that non-surgeons can use it to provide thorough debridement when surgery is not available or is not the optimal choice. This means that it is also possible to provide surgical quality debridement as an outpatient or in the home.
• Low cost of treatment.

Common misconceptions about maggot therapy

Common Misconceptions	The Truth
“Patients would not want maggots on them”	What patients do not want is a stinking, draining wound. What patients do not want is to lose their foot. What patients do not want is 4 more weeks of a treatment in which they do not see any benefit. To someone with a non-healing wound, wearing “baby flies” for 2 days is not too high a price to pay, if the potential for success is what is reported with MDT.
“It might not be possible to get out all the maggots after treatment”	The maggot dressing is removed as soon as the maggots have finished secreting their proteolytic (tissue-dissolving) enzymes (within 48-72 hours). At that time, their natural instinct is to leave the wound and crawl away as quickly as possible. So when the dressing is opened, the maggots will be “at the gate,” eagerly awaiting their release. If any slow growing larvae remain, they can be removed with a simple wipe, wash, or irrigation.
“If one of the maggots is left in, it might bury itself in the tissue or crawl around”	If any maggot is overlooked (for example, it was slow growing, and hid in the recesses of the wound when the dressing was opened), it will continue to feed on the dead tissue of the wound only as long as dead tissue is present, and probably only for a maximum of 12-24 hours. Medical grade maggots do not bury in or feed on healthy tissue. What’s more, they are obligate air-breathers. Therefore, they must remain where there is air, and they will leave the body as soon as they are finished feeding or as soon as there is no more dead, infected tissue left.
“Medicinal maggots are sterile, so they can not reproduce or turn into flies”	Medical grade maggots are often called “sterile maggots,” but the use of the word “sterile” means germ-free. They are best called “disinfected maggots.” They can mature into flies (although it will take them about 3 weeks, and they can then reproduce. However, all larvae are immature, and can not reproduce until reaching adulthood.
“Medicinal maggots might reproduce in the wound, making even more maggots”	Not true. Larvae of all species are immature, and can not reproduce.
“Medicinal maggots are no longer available”	Medical maggots are readily available from several sources, in many countries. See below for a list of suppliers.
“Medicare, Medicaid, and private insurance will not cover maggots or maggot therapy”	In the U.S., maggot therapy should be coded with an appropriate procedure code for “selective debridement without anesthesia” (i.e., CPT codes 97597 or 97598) or a CPT code for misc. skin procedures (i.e., 17999). While it is true that CMS declined to issue a national code (HCPCS code) for the maggots themselves, they can and should be billed as an additional expense, and will generally be covered by private and governmental third-party payers. When billing for the maggots themselves, consider using either the ABC code for maggots (EAACT) or the HCPCS code for misc. devices (A9270). Appeal may be necessary. The BTER Foundation will assist with appeals. For those without financial resources, the BTER Foundation provides Patient Assistance Grants. Additional information can be found in the recent press release by the BTER Foundation.
“Maggot therapy might hurt if the maggots bite me”	Maggots do not bite. They do not have teeth. They do have modified mandibles though, called “mouthhooks,” and they have some rough bumps around their body which scratch and poke the dead tissue, one of the mechanisms that debrides the wound. It is similar to a surgeons “rasper,” but on a microscopic scale. The maggots are so small when applied that they can not even be felt within the wound. Those patients who already have wound pain before beginning maggot therapy, perhaps due to exposed nerves or other reasons, may have some pain during maggot therapy when the maggots become large enough to be felt crawling over those nerves (usually at about 24 hours). Those patients should be given access to pain medications (analgesics); but if pain medication is inadequate to relieve the discomfort, the maggots can be removed early. Once the dressings are removed, the maggots will crawl out and the pain should cease immediately. If further debridement is necessary, another MDT dressing can always be applied later, but it should be used only for a brief period, again, until the patient is uncomfortable.
“Sure, medical maggots are cheap; but garbage maggots are even cheaper, and should be just as good”	While it is true that the species used to make medical grade maggots are found in the wild, so too are thousands of other species; and not all species are safe and effective. In fact, the literature suggests that not all strains of the same species are equally safe and effective. What’s more, wild maggots may carry pathogens even more harmful than the ones already on the wound. Therefore, it is prudent to use medical grade maggots that have been demonstrated to be disinfected (germ-free), safe, and effective.

Information for health care providers

Medicinal maggots have three actions:

1) they debride (clean) wounds by dissolving the dead (necrotic), infected tissue; 2) they disinfect the wound, by killing bacteria; and 3) they stimulate wound healing.

In the U.S., indications listed on the package insert include: “. . . debriding non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers, and non-healing traumatic or post surgical wounds.”

There are many reports about maggot therapy also being used for other wounds, suck as burns, osteomyelitis, fasciitis, clean but non-healing wounds . . . but these are not currently approved indications for any medicinal maggots currently on the market.

The BTER Foundation, in collaboration with community leaders, drafted a MDT Policies & Procedures template for hospitals and clinics to use when writing policies for their facility. The template is available for free download.


Information for patients

Maggot therapy is an effective, accepted method of treating chronic, non-healing wounds. Only specially selected, tested, disinfected larvae are applied to the wound surface and covered with a dressing that prevents the larvae from escaping. They are easily and completely removed 2 or 3 days later. Sometimes the wound is completely cleaned by then; sometimes additional treatments may be necessary. After maggot therapy, the wound may be clean enough to close, cover, graft, or flap. Your doctor will be able to suggest the best treatment to follow.


How to find a therapist

If you are looking for a therapist to evaluate your wound for maggot therapy, first ask your current physician or surgeon. S/he knows you already, and can provide local care and follow-up. The procedure is simple enough that most licensed therapists can do it with ease. Courses are available (see BTER Foundation) and your current doctor or wound care therapist may have already had experience.

Frequently asked questions

How do you keep the maggots on the wound?	Because the natural tendency of the maggots is to wander off before and after they have finished feeding, they must be kept in place by dressings that allow air to enter, allow liquefied necrotic tissue to drain out, and still keep the maggots securely over the wound. This can be done with a porous, mesh-like covering (i.e., nylon netting) affixed to the wound border (by tape, or glued to a hydrocolloid pad). It is removed 48-72 hours later, and the maggots removed.
How do you get all of the maggots out?	Once the dressing is removed, all of the maggots should crawl out of the wound and away from the host because they will be satiated and ready to migrate. Remaining maggots can be wiped off with a wet gauze pad. If there are any young larvae still there that you can not remove, simply cover the wound with moist gauze and replace it three time/day; the remaining maggots will leave the wound and bury themselves in the gauze within 24 hours.
How do I dispose of the maggot dressings?	Maggots are germ-free when applied, but become contaminated when they come into contact with the patient’s wound flora. Therefore, MDT dressings should be handled like all other infectious dressing waste. Place the maggot dressings in a plastic bag and seal the bag completely. Then place the sealed bag into a second plastic bag and seal completely. Place the bag with the other infectious dressing waste in an appropriate infectious waste bag and autoclave or incinerate within 24 hours, according to waste management policies.
How do I dispose of unused maggots?	Unused maggots are germ-free. They may be discarded in regular trash bins. Seal their vial so that they can not escape.
How many treatment cycles are necessary?	The number of treatment cycles depends on the size of the wound and the ultimate goal of treatment (debridement, wound preparation for graft, or wound closure). The average course is 2-4 cycles. Examine the wound after treatment (and 24 hours later, if possible), to determine if another treatment is necessary.
Does maggot therapy hurt?	For those few patients who feel wound pain, they will likely also feel pain or discomfort with maggot therapy as the maggots become large enough to feel (about 24-36 hours into the treatment cycle. Use analgesics liberally, and remove the dressings if/when analgesics fail to control pain. The pain will abate immediately after the dressing is removed.

References :

http://www.medicaledu.com/maggots.htm

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