Editor's Rant: Communicating the data and about the data...

It is pretty damn hard work trying to get hold of data on virus outbreaks around the world. 

When it is, it may be available in unfriendly formats. It may not be made public at all. When it is available, it is often slow to appear or it may have random reporting gaps, or be partially incomplete. The style of the released data can change overnight as well, sometimes going from detail to summary.

So why bother about trying to get hold of these numbers at all? It's not like I work in the field. Well, that is a question I'm increasingly asking myself of late too. My personal reason has been because I think there need to be more voices in the vacuum between the numbers being reported and the often dry public health reports. I think scientists, even if they are not lifetime experts on a given virus or outbreak, still have much to offer when they come out from behind their manuscripts and apply their skills to interpreting what's happening. Well, many do anyway. And they should do it more. Now, perhaps more than ever, science needs steer away from its cold, dense and boring niche writing to a chattier, more helpful and community-based style of engagement. It astonishes me how often the public's interpretation of outbreak numbers must come from the media or from hobbyists, or even professionals who work in other areas and give of their own time to help explain something to us in their personal time. Helpful and engaging information and better access should come from the source of the data.

So it becomes really annoying (you would have to know me quite well to know how many times I just rewrote those words) when data are given out for public use that are a total mess...and there is not one tiny mote of explanation for it. I called it appalling on Twitter tonight. And at other times there are no explanations for why there are gaps, why data are delayed, why the format may have changed today compared to last week, why a line list is missing a case, using a new and totally independent numbering scheme or suddenly reshuffled, why there is no news about a new outbreak. No word. No contact. No-one taking the lead. No...communication.

I have met a lot of people since I have been blogging who, in various ways, have put in their own personal time to help out bigPublicHealth, to help take up the slack in communicating to the media and to the public. It is hard to quantify the impact of that combined help-but I can assure you that it reaches far and wide and is not insignificant. One would think that it should be easier to provide this help when one is willing to make use of their own time and use their own resources, or that those people should be shown enough respect to be able to simply find and apply reliable raw data so they can help out. But one would be an idiot. I very clearly remember a time when I could send a public Tweet to WHO's Head of Public Relations, Gregory Haertl, and get an informed reply. Those days have passed. I remember there being an #AskEbola channel on Twitter that gave answers. That engagement is just not there anymore. I'm sure its funding and resources and blah blah...but not as sure as I could be if that were spoken about in public. Communication. Someone needs to step up on this. As the quotes above allude to, 2015 is not 2014. And one of those differences is that everyone wants timely and comprehensive information they can rely on during times of outbreak. This hasn't been discusses enough but it should be.
 

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Ebola virus: wild and domestic animals, plants and insects...

Initial Ebola virus (EBOV) infection of humans is a rare zoonotic spillover event.  

Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquatebats, all fruit-eating megabats of the familyPteropodidae, are considered to be important reservoir hosts, yet they do not show signs of disease.[1] 

While a great deal remains unknown about the identity and spectrum of natural ebolavirus hosts,[1] zoonoses appear to co-occur with bat pregnancy.[2]

Animals that have died from ebolavirus infections include:[3,4]

• Duiker (Cephalophus sp.; an antelope) 
• Gorilla (Gorilla gorilla) 
•  Chimpanzee (Pan troglodytes)

Living animals found to harbour ebolavirus RNA include:[1,4,23]

• Cynomolgus macaque monkey (Macaca fascicularis; RESTV) 
• Franquet�s epauletted fruit bat (Epomops franqueti; EBOV) 
• Hammer-headed bat (Hypsignathus monstrosus; EBOV) 
• Little collared fruit bat (Myonycteris torquata; EBOV)

Those animals with only antibodies to EBOV in the absence of infectious virus, suggesting past exposure include:[5,6]

• Domestic dogs (Canis lupus familiaris) 
• Peter�s lesser epauletted fruit bat (Micropterus pusillus; fruit-eating) 
• Angolan free-tailed bat (Mops condylurus; insect-eating) 
• Giant roundleaf bat (Hipposideros gigas; insect-eating) 
• Egyptian fruit bat (Roussetus aegyptiacus; fruit-eating) 
• Geoffrey�s rousette (Rousettus amplexicaudatus; a bat species; fruit-eating) 
• Lord Derby�s scaly-tailed squirrel (Anomalurus derbianus)

Porcupines (Hystrix cristata) have been implicated as a source for human EBOV exposure but virus-positive animals have not been documented.[4] 

Between nine and 25% of 337 domestic dogs from various towns and villages in Gabon during an EBOV outbreak in 2001-2002 were identified as possible hosts for EBOV when found to be seropositive.[7,8] It was not known when they became seropositive nor has it been experimentally determined that dogs are able to host an active EBOV infection.[9,10] Dogs were observed in contact with suspected virus-laden fluids and with other animals during the Gabon outbreak but seropositive dog specimens did not contain EBOV antigen or viral RNA. Three specimens from these seropositive dogs did not yield infectious virus in cell culture either and thus there remains no documented evidence for a canine source of human EBOV infection. In 2014, two dogs owned by human cases of EBOV/Mak in Spain (euthanized without testing [11]) and the United States of America (tested negative for EBOV[12,13]) did not exhibit any signs of disease. 

Domestic pigs have been found to be a natural host for the Reston ebolavirus[9,14] and antibodies to EBOV have also been found in guinea pigs, an animal that can also be experimentally infected.[15] Domestic dogs and guinea pigs appear to become infected without symptoms.[6,7] Horses, mice, guinea pigs and goats have been experimentally inoculated with EBOV to produce antisera or test therapeutic preparations.[16,17] 

Pigs experimentally infected with a member of the Zaire ebolavirus become symptomatic.[8] NHP, guinea pigs and mice have been used to examine aspects of disease progression and exhibit various degrees of disease when experimentally infected.[18,19] 

On a few occasions in one study into possible hosts, a low viral load of EBOV could be sporadically recovered after inoculation of a snake (up to 11 days post inoculation), a mouse (up to nine days later) and a spider (21 days later) but the authors of this study concluded that these results could have represented residual inoculum.[21]

Plants, arthropods, cows, cats and sheep have not been found to naturally carry or host ebolavirus infection but only small numbers of some species have been examined.[3,20-22]

References...

1. Leroy EM, Kumulungui B, Pourrut X, et al. Fruit bats as reservoirs of Ebola virus. Nature 2005;438:575-6. 
2. Plowright RK, Eby P, Hudson PJ, et al. Ecological dynamics of emerging bat virus spillover. Proc Biol Sci 2015;282:20142124.
3. Olson SH, Reed P, Cameron KN, et al. Dead or alive: animal sampling during Ebola hemorrhagic fever outbreaks in humans. Emerg Health Threats J 2012;5
4. Lahm SA, Kombila M, Swanepoel R, Barnes RF. Morbidity and mortality of wild animals in relation to outbreaks of Ebola haemorrhagic fever in Gabon, 1994-2003. Trans R Soc Trop Med Hyg 2007;101:64-78.
5. Marsh GA, Haining J, Robinson R, et al. Ebola Reston virus infection of pigs: clinical significance and transmission potential. J Infect Dis 2011;204 Suppl 3:S804-9.
6. Gonzalez JP, Herbreteau V, Morvan J, Leroy EM. Ebola virus circulation in Africa: a balance between clinical expression and epidemiological silence. Bull Soc Pathol Exot 2005;98:210-7.
7. Allela L, Boury O, Pouillot R, et al. Ebola virus antibody prevalence in dogs and human risk. Emerg Infect Dis 2005;11:385-90.
8. Weingartl HM, Nfon C, Kobinger G. Review of Ebola virus infections in domestic animals. Dev Biol (Basel) 2013;135:211-8.
9. Stansfield SK, Scribner CL, Kaminski RM, Cairns T, McCormick JB, Johnson KM. Antibody to Ebola virus in guinea pigs: Tandala, Zaire. J Infect Dis 1982;146:483-6.
10. Connolly BM, Steele KE, Davis KJ, et al. Pathogenesis of experimental Ebola virus infection in guinea pigs. J Infect Dis 1999;179 Suppl 1:S203-17.
11. Why Dallas Won't Kill The Dog Of The Texas Nurse With Ebola. Business Insider, 2014. (Accessed 27/4/2015, at http://www.businessinsider.com.au/what-will-happen-to-dallas-nurses-dog-2014-10 )
12. Starting today, Dallas Animal Services will begin testing Nina Pham�s year-old dog Bentley for Ebola. The Dallas Morning News, 2014. (Accessed 17/4/2015, at http://thescoopblog.dallasnews.com/2014/10/starting-today-dallas-animal-services-will-begin-testing-nina-phams-year-old-dog-bentley-for-ebola.html/.)
13. EBOLAVIRUS, ANIMAL RESERVOIR (05): USA, DOG, NOT. 2014. (Accessed 01/05/2015, at http://promedmail.org/direct.php?id=20141026.2901733 )
14. Barrette RW, Metwally SA, Rowland JM, et al. Discovery of swine as a host for the Reston ebolavirus. Science 2009;325:204-6.
15. Rouquet P, Froment JM, Bermejo M, et al. Wild animal mortality monitoring and human Ebola outbreaks, Gabon and Republic of Congo, 2001-2003. Emerg Infect Dis 2005;11:283-90.
16. Kudoyarova-Zubavichene NM, Sergeyev NN, Chepurnov AA, Netesov SV. Preparation and use of hyperimmune serum for prophylaxis and therapy of Ebola virus infections. J Infect Dis 1999;179 Suppl 1:S218-23.
17. Bray M, Davis K, Geisbert T, Schmaljohn C, Huggins J. A mouse model for evaluation of prophylaxis and therapy of Ebola hemorrhagic fever. J Infect Dis 1998;178:651-61.
18. Ebihara H, Takada A, Kobasa D, et al. Molecular determinants of Ebola virus virulence in mice. PLoS Pathog 2006;2:e73.
19. Geisbert TW, Young HA, Jahrling PB, Davis KJ, Kagan E, Hensley LE. Mechanisms underlying coagulation abnormalities in ebola hemorrhagic fever: overexpression of tissue factor in primate monocytes/macrophages is a key event. J Infect Dis 2003;188:1618-29.
20. Turell MJ, Bressler DS, Rossi CA. Short report: lack of virus replication in arthropods after intrathoracic inoculation of Ebola Reston virus. Am J Trop Med Hyg 1996;55:89-90.
21. Swanepoel R, Leman PA, Burt FJ, et al. Experimental inoculation of plants and animals with Ebola virus. Emerg Infect Dis 1996;2:321-5.
22. Ebola haemorrhagic fever in Sudan, 1976. Report of a WHO/International Study Team. Bull World Health Organ 1978;56:247-70.
23. Miranda ME, Ksiazek TG, Retuya TJ, Khan AS, Sanchez A, Fulhorst CF, Rollin PE, Calaor AB, Manalo DL, Roces MC, Dayrit MM, Peters CJ. Epidemiology of Ebola (subtype Reston) virus in the Philippines. J Infect Dis. 1999 Feb;179 Suppl 1:S115-9.

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Snapdate: Ebola virus disease 2014/2015 by map...

Click on map to enlarge.

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Ebola Returns To Liberia With A Mysterious Case Near Monrovia

Almost two months after Liberia was declared Ebola-free, the disease has cropped up again — this time in a rural town outside the capital city.

So far, there's only one new case, but health officials are rushing to stop its spread.

Liberia's deputy health minister, Tolbert Nyenswah, said Tuesday that a 17-year-old boy died of Ebola at his home in Nedowein, a village near the country's international airport.

"There is no need to panic. The corpse has been buried, and our contact tracing has started work," Nyenswah told Reuters. Health officials have already started quarantining homes near where the body was found.

But there are a few reasons why the case is worrisome.

First, it's not known where or how the teenager caught Ebola. "There is no known source of infection, and there's no information about him traveling to Guinea or SL [Sierra Leone]," the ministry of health told Science magazine in an email.

Second, health officials didn't know the teenager had Ebola until after he died. So he could have unwittingly spread the disease to his family and caretakers.

Finally, many international aid groups have left Liberia since cases plummeted to zero back in March. The case will test Liberia's ability to stop an outbreak largely on its own.

The World Health Organization declared the country Ebola-free May 9. But neighboring countries Guinea and Sierra Leone are still struggling to stop the virus. Last week, the two countries reported 20 cases total, the WHO said.

Since Ebola erupted in West Africa, there have been 27,443 reported cases, More than 11,000 people have died.

[Original Article]

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Grapefruit, orange juice linked to increased risk of melanoma

Published in the Journal of Clinical Oncology, the study found people who consumed high amounts of whole grapefruit or orange juice were over a third more likely to develop melanoma, compared with those who consumed low amounts.

However, lead study author Dr. Shaowei Wu, of the Department of Dermatology at the Warren Alpert Medical School of Brown University in Providence, RI, and colleagues stress that further research is needed before any changes are made to recommendations for orange and grapefruit consumption.

According to the American Cancer Society, 73,870 people in the US will be diagnosed with melanoma this year and 9,940 people will die from the cancer.

The primary risk factor for melanoma is exposure to ultraviolet (UV) radiation from the sun and indoor tanning devices, such as tanning beds and sun lamps.

Past research has suggested that tanning lotions containing psoralens - a group of naturally occurring substances called furocoumarins that are found in citrus fruits - may increase the risk of melanoma by sensitizing the skin to the effects of UV radiation.

For their study, Dr. Wu and colleagues set out to see whether consumption of citrus fruits may be associated with greater risk of melanoma.

The team analyzed data from 63,810 women who were part of the Nurses' Health Study between 1984 and 2010, as well as 41,622 men who were part of the Health Professionals Follow-Up Study between 1986 and 2010.

All participants completed dietary questionnaires at least every 4 years, from which the researchers were able to gather information on their citrus fruit intake. In the study, a serving of citrus fruit was defined as the equivalent to one orange, half a grapefruit or one 6 oz glass of whole orange or grapefruit juice.

The participants also completed health questionnaires every 2 years, which detailed lifestyle factors - such as smoking status and physical activity levels - and medical history. Subjects with a history of cancer were excluded from analysis.

Consuming citrus fruits more than 1.6 times daily linked to 36% higher melanoma risk

During the 24-26-year follow-up, 1,840 participants were diagnosed with melanoma.

The researchers found that the more servings of oranges, grapefruits or juices from these fruits that the participants consumed overall, the higher their risk of melanoma. Subjects who consumed a serving of these fruits or their juices at least 1.6 times a day, for example, were found to be at 36% higher melanoma risk.

On analyzing melanoma risk by consumption of individual citrus products, the researchers found that grapefruit juice and whole oranges were not independently associated with greater risk of the cancer.

Fast facts about melanoma

• In the US, rates of melanoma have been increasing for the past 30 years
• The average age at melanoma diagnosis is 62, though it is still common among younger adults
• White Americans are around 20 times more likely to develop melanoma than African-Americans.

Eating whole grapefruit, however, was strongly associated with high melanoma risk, and this risk was found to be independent of confounding factors, such as age, smoking status, alcohol and coffee intake, use ofvitamin C supplements and physical activity levels.

Individuals more susceptible to sunburn as a child or teenager and those who had higher exposure to direct sunlight were at highest risk of melanoma from whole grapefruit consumption, the researchers found.

Orange juice was also associated with greater melanoma risk, which the researchers say is most likely because consumption of this product was much higher than consumption of other citrus products.

Though Dr. Wu and colleagues did not investigate the mechanisms underlying the association between citrus fruit consumption and melanoma risk, they speculate that it may be because the fruits are rich in psoralens and furocoumarins, which are believed to make the skin more sensitive to the sun.

"These substances are potential carcinogens, as found in both mice and humans. Psoralens and furocoumarins interact with UV light to stimulate melanoma cells to proliferate," explains Dr. Marianne Berwick, of the University of New Mexico in Albuquerque, in an editorial linked to the study.

However, the team notes no association was found between consumption of other foods rich in furocoumarins - such as celery and carrots - and increased risk of melanoma. But Dr. Wu says this is likely because people often cook these vegetables, and the heat reduces furocoumarin levels.

A 'public overreaction' to these findings should be avoided

According to Dr. Gary Scwartz, expert at the American Society of Clinical Oncology (ASCO), the findings from Dr. Wu and colleagues are "intriguing," though he says it is far too soon to make any changes to recommendations regarding citrus fruit consumption.

Dr. Wu adds:

"While our findings suggest that people who consume large amounts of whole grapefruit or orange juice may be at increased risk for melanoma, we need much more research before any concrete recommendations can be made.

At this time, we don't advise that people cut back on citrus - but those who consume a lot of grapefruit and/or orange juice should be particularly careful to avoid prolonged sun exposure."

Dr. Berwick says this is a "potentially important" study, noting that citrus consumption is widely promoted for its health benefits. For example, past research has suggested grapefruit can aid weight loss and improve heart health.

However, she notes that at present, a "public overreaction" that may cause people to shun citrus fruits should be avoided.

"For people who would be considered at high risk, the best course might be to advise individuals to use multiple sources of fruit and juice in the diet and to use sun protection, particularly if one is sun sensitive," she adds. "There is clearly a need for replication of the study findings in a different population before modifying current dietary advice to the public."

Dr. Wu and colleagues plan to conduct a study that involves measuring furocoumarin levels in blood samples of subjects who consume high levels of citrus fruits, in order to determine whether it is these substances that may drive greater melanoma risk.

[Original Article]

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Slam Dunk for Diabetes Camp offers lessons on and off the court

SCHERERVILLE | Some youngsters may think that living with diabetes means playing competitive sports is off limits.

Not so the 40 youths who attended fifth annual Moses E. Cheeks Slam Dunk for Diabetes Basketball Camp at Franciscan Omni Health and Fitness last month.

The camp is offered for diabetic youth 5 to 18, with diabetes educators from Omni, Franciscan Alliance hospitals and other area health providers on hand to assist the youngsters.

But they weren't the big draw. Coaches Anthony Wofford, Tavell Grant and Robert Dutton, all from the Chicago Bulls Training Academy were the ones who got the most attention as they conducted drills and taught dribbling, passing and shooting techniques to the youngsters.

The program, which began in 2005, teaches fundamentals of living with diabetes and offers a place where attendees gain confidence in a safe, structured and supportive atmosphere. The program is designed to teach participants the relationship between food, exercise and insulin, as well as basketball skills.

It likewise is designed to teach campers how sports, illnesses and stress affect blood sugar levels, how to make corrections to insulin intake and to demonstrate that diabetes need not prevent one from living a full, active and productive life.

The camp is named for the father of Maurice Cheeks, a National Basketball Association coach. Moses Cheeks, who had pancreatic cancer and Type 1 diabetes, was a basketball enthusiast who was instrumental in designing the camp.

[Original Article]

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Ebola mysteriously returns to Liberia...[UPDATED]

v2-1JULY2015 AEST
In a gut-wrenching, but not wholly unexpected event, a new case of Ebola virus disease (EVD) has popped up in a town called Nedowein (or Nedowian [8]), about 50km south west of Liberia's capital, Monrovia.

Liberia had been declared a country free of EVD on 9-May-2015 - 52 days ago, or 1 month, 21-days, or 1248 hours.  

The 17 year old male (17M) died on Wednesday (about 6 days ago) and has already been buried by all accounts. Samples from his corpse tested positive at least twice.[3]

It's not an unexpected event because both Guinea and Sierra Leone, adjoining countries, continue to struggle with EVD and have been unable to stop the disease from spreading, even though in relatively small numbers compared to what was occurring in 2014. 

What makes this new case in Liberia a little mysterious is that 17M died far from the border with either of these countries; approximately 150km from Sierra Leone's south-eastern border and about 200km from the nearest Guinean border. Sure, these are not insurmountable distances to travel while incubating an Ebola virus infection, but it would have been a simpler call that this was an imported case if it had occurred on or nearer to the border of one of the two countries with ongoing disease. However, it seems the young man did not travel outside Liberia.[8]

Hopefully the contact tracing and investigations that are going on now will find that 17M simply made contact with someone who had traveled from outside of Liberia, perhaps to Nedowein, which is described as the home town of 17M.[2,7] If this is not an imported case then one is left to wonder about various other scenarios including:

1. sexual or other less common transmission of Ebola virus from an as yet undiscovered convalescent EVD case
2. contact with an unknown case who had traveled across the border from a country with EVD
3. a new zoonotic acquisition of a different Ebola virus variant
4. there may still be clusters of EVD within Liberia that have been smouldering on without the knowledge of any authorities

Time and further hard work will no doubt tell.

UPDATE: A second  case, associated with 17M ("Abraham") has been diagnosed.[9] Some discussion is evolving around the consumption of dog meat by 17M,[11] however, the same questions around how a dog would become infected (no record of the detection of active replication in a dog have been recorded to date, although antibodies have suggested the possibility in earlier outbreaks) will apply.

Further reading...

1. http://www.frontpageafricaonline.com/index.php/news/5660-ebola-back-in-liberia-1-month-20-days-after-free-declaration
2. http://www.bbc.com/news/world-africa-33323664
3. http://www.ibtimes.com/ebola-liberia-corpse-tests-positive-deadly-virus-weeks-after-liberia-declared-ebola-1989248
4. http://bigstory.ap.org/article/581e523aeb1144f68aa1a1629b0e9252/liberian-official-says-corpse-tests-positive-ebola
5. http://news.yahoo.com/liberia-announces-return-ebola-one-death-094057018.html
6. http://www.nytimes.com/2015/06/30/world/africa/liberia-new-ebola-death-is-reported.html
7. http://newsworldmap.com/ebola-returns-to-liberia-but-health-minister-tells-public-no-need-to-panic-washington-post/ 
8. http://news.sciencemag.org/africa/2015/06/liberias-puzzle-how-did-new-ebola-patient-become-infected 
9. http://www.nytimes.com/2015/07/01/world/africa/liberia-ebola-epidemic.html?partner=rss&emc=rss&smid=tw-nytimesscience&_r=0  
10. http://frontpageafricaonline.com/index.php/health-sci/5667-ebola-mystery-dog-meat-story-eclipses-border-lapse-theory

Version history..

1. New links added; town name variation added from Science report; hypothesis of contact with another imported case - #2; note on lack of travel outside of Liberia; announcmene tof a 2nd case

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Trade union steps up efforts to save veterinary laboratory

A TRADE union has called for all opponents of plans to close a world-class veterinary laboratory to work together after holding talks with the local MSP.

Prospect warned following talks with Highlands and Islands MSP David Stewart that closure of the Inverness facility, which carries out post-mortems on livestock, would increase the chances of spreading infections.

Union officials argue that Highlands farmers are forced to transport carcases over hundreds of miles to the next nearest specialist disease surveillance centres in Aberdeen, Perth or Thurso.

It has also highlighted the risk of farmers simply burying dead animals rather than undertake the arduous journey. Smaller farmers and crofters will be hardest hit, it says.

Alan Denney, Prospect national secretary said: "There is a growing outcry at these plans from both farmers - whose livelihoods depend on effective disease surveillance - and the wider public. The work of this lab is unique in the Highlands and Islands and as such it is irreplaceable

"But if we are going to stop these plans opponents must set aside any political differences and speak with one voice. The consequences of failure could have grave consequences for farmers, human health and the Scottish economy.

Inverness site owners, Scotland's Rural Collegehas justified the plans on the basis of the Kinnaird Review of Veterinary Surveillance.

It said feedback is still on-going and welcomed all suggestions and ideas about how it can provide a good service before a final decision is made in consultation with the Scottish Government.

[Original Article]

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'Eat carbohydrates last' advice for people with diabetes

“Eating protein and veg BEFORE carbs…could help diabetics control their blood sugar,” the Mail Online reports. However, the advice is based on a very small study and the influence of food ordering really needs to be checked in much larger studies before it can be made an official guideline.

The study involved just 11 people, most of whom had obesity-related type 2 diabetes, who ate the same meal one week apart.

On the first occasion, they ate the carbohydrates 15 minutes before the protein and veg; on the second occasion, they reversed the order.

Post-meal blood glucose was significantly lower when the carbohydrates went last compared with first.

The study lends support to previous research that carbs have the biggest effect on blood glucose. However, the study has many limitations, which require larger and longer-term studies to resolve.

For example, it is not known what the effects would be of sustaining this eating pattern in the longer term.

Though it is unlikely to cause you any harm to consider altering the order you eat food items to put carbohydrates last, the most important thing for people with and without diabetes is to follow a healthy, balanced diet.

If you do have diabetes, never make any drastic changes to your diet without first consulting with the clinician in charge of your care.

Where did the story come from?

The study was carried out by researchers from Weill Cornell Medical College, New York, and was funded by the Clinical and Translational Science Center at Weill Cornell Medical College, and the Dr. Robert C. and Veronica Atkins Curriculum in Metabolic Disease at Weill Cornell Medical College Grant.

The study was published in the peer-reviewed medical journal Diabetes Care, on an open-access basis, so the research is free to read online or download as a PDF.

The Mail’s coverage has not considered the various important limitations of this small pilot study. For one, its headline “The order you eat your food affects your health” is incorrect. Though it may be inferred that a sustained effect on blood glucose control could help people with type 2 diabetes, this study hasn’t looked at longer-term health effects or measured any health outcomes at all.

What kind of research was this?

This was a small crossover study designed to investigate the effect the order of food consumption has on blood glucose level after eating on people with type 2 diabetes.

The researchers explain how post-meal glucose is a good indicator of blood glucose control and the risk that a person has of diabetes complications. There is said to be existing evidence that carbohydrate is the food type that has the biggest effect on blood glucose. Some studies have shown that eating whey protein before a meal reduces post-meal levels, but there is said to be little information on the effect of food order on people with type 2 diabetes. This is what this pilot study aimed to look at.

What did the research involve?

This study involved 11 adults (six female, five male) with treated type 2 diabetes, who were involved in an existing study of the effects of food order on post-meal glucose when eating a typical Western diet including vegetables, proteins and carbohydrates. The participants had an average age of 54 years and were obese (their average body mass index was 32.9).

Participants attended the study centre for two test occasions, one week apart. On each occasion, they were fasted for 12 hours overnight before eating the same 628-calorie meal made up of 55g protein, 68g carbohydrate and 16g fat.

On the first visit, they ate carbohydrates (ciabatta bread and orange juice), followed 15 minutes later by protein (skinless grilled chicken breast) and vegetables (lettuce and tomato salad, with low-fat Italian vinaigrette and steamed broccoli with butter). On the second visit, the food order was reversed so that the carbohydrates went last. On both occasions, blood glucose was measured before the meal and 30 minutes, one hour and then two hours after.

What were the basic results?

When vegetables and protein went first, average post-meal blood glucose was significantly reduced at all time points compared to when carbohydrate went first. Blood glucose was 28.6% lower at 30 minutes, 36.7% lower at one hour and 16.8% lower at two hours after the meal.

Insulin levels were also lower at one and two hours, suggesting that the body did not need to produce so much insulin to control blood sugar.

How did the researchers interpret the results?

The researchers conclude from their pilot study that “the temporal sequence of carbohydrate ingestion during a meal has a significant impact on [post-meal] glucose and insulin”.

In short, they thought the order you eat carbohydrates during a meal affects your glucose and insulin levels afterwards.

Conclusion

This pilot study seems to support the findings of previous research that eating carbohydrates has a significant effect on post-meal blood glucose. Eating carbohydrates first, before protein and vegetable portions, raised glucose levels more than eating carbs at the end of the meal. This study specifically tested obese people with type 2 diabetes and showed that the effects seem to hold true.

While the research suggests that ordering the meal could control blood sugar levels, particularly in people with type 2 diabetes, there are several important points to bear in mind.

Size of study

This was a very small study involving only 11 people with type 2 diabetes. The results from this small group may not be identical to those that would have been obtained from other or much larger samples of people.

Short-term follow-up

The effects have only been measured in the immediate term, up to two hours after a single meal. It is not known whether there would be a meaningful difference in blood glucose control if this carbs-last pattern of eating were continued in the longer term at each meal.

The study doesn’t show whether altering food order could improve blood glucose control long term in type 2 diabetes, thereby reducing the risk of disease complications.

Neither does the study inform whether altering food order could help people with or without diabetes to lose weight and reduce the risk of being overweight or obese.

Uncertainty on timing

They tested eating only one specific meal first thing in the morning. It is completely unknown from this study how effects may differ, depending on factors such as the time of day food was eaten, if it was of a different composition of foods rather than this specific meal, or if it was of different calorie content.

Practicality

On a practical level, this study involved eating the carbs 15 minutes from the protein and vegetable components. This isn’t always going to be practical in normal daily life, when the different components are often combined and eaten at the same time. It is not known from this whether you need the 15-minute time delay. For example, if you were eating food on a plate that had rice or potatoes, whether you could obtain the same effect on blood glucose if you ate the carbs last, but immediately after eating the other food stuff.

Overall, longer-term studies will be needed to see if reversing food order could have sustained meaningful effects on blood glucose control in type 2 diabetes.

Though it is unlikely to cause you any harm to consider altering the order you eat food items, the most important thing for people with and without diabetes is to follow a healthy, balanced diet.

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Rapid test for Ebola developed by Cardiff firm BBI

BBI says its Ebola test could provide results in 20 minutes and could be used at borders to control the spread of the virus

A rapid test for the Ebola virus which could provide a result in 20 minutes has been developed by Cardiff-based diagnostics business BBI.

To date there have been more than 27,000 cases of Ebola reported and 11,000 deaths in West Africa from the virus.

The BBI Group's test, which is in the process of being verified to allow EUA submission, will be used to test patients suspected of Ebola infection to screen and potentially help with how they are subsequently managed.

Accurate diagnosis currently relies on skilled laboratory staff and equipment, largely unavailable in the field, resulting in delays in diagnosis and difficulty containing spread of the virus.

BBI says its development will make testing simpler and quicker than existing tests for Ebola.

With minimal training, local health teams can complete the test at bedside and have a result in 20 minutes.

Ebola

27k

Number of reported cases

11k

Number of deaths in West Africa from the virus

20

Minutes to get result from BBI test

In field data suggests the test could be used as a negative agreement ‘rule-out’ test and screening method.

In the future, such a test could possibly be deployed at borders to monitor and control spread of the virus.

Leigh Thomas, chief commercial officer at BBI, said: “BBI has developed high performance lateral flow tests for some of the world’s leading diagnostic companies for over 25 years.

"Our expertise and flexibility has allowed us to quickly deploy a team and develop a rapid test in 9 months which, based on field testing, promises to have an immediate and positive impact on the Ebola crisis.

"We are pleased that our test will meet an immediate need in the field and ultimately improve the lives of others”.

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