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Health News from NHS Choices

Constantly updated health news across a range of subjects.

NHS Choices News

  • Reports of an 'end to daily diabetes jabs' are premature

    "The daily trial of insulin injections could soon be over for hundreds of thousands of people with type-1 diabetes," is the overoptimistic headline in The Times.

    A small study involving immune "T-reg cells" proved safe for participants, but it is far too early to talk about an end to daily injections.

    In type 1 diabetes the body's immune cells attack the insulin-producing beta cells in the pancreas. Without the hormone insulin, people with type 1 diabetes can't control the levels of sugar in their blood.

    High levels of sugar (hyperglycaemia) can damage the blood vessels and nerves, while low levels (hypoglycaemia) can cause unconsciousness. Most people with type 1 diabetes need to inject insulin regularly.

    It was already known that people with type 1 diabetes have fewer cells called T-regulators (T-regs), which are involved in stopping the immune system attacking healthy cells such as beta cells. Now a group of scientists has found a way to take T-regs from people's blood, filter out any defective cells, and expand the numbers of healthy T-regs so they can inject them back.

    This study was to test whether the technique is safe, rather than effective. The researchers say they can't tell from the varied responses of the 14 people in the study whether the treatment actually helped preserve insulin production, let alone restore it. 

    Where did the story come from?

    The study was carried out by researchers from the University of California, Benaroya Research Institute in Seattle, Yale University and KineMed Inc.

    It was funded by the Juvenile Diabetes Research Foundation International, the Brehm Coalition, the Immune Tolerance Network, BD Biosciences and Caladrius Biosciences. 

    The study was published in the peer-reviewed journal Science Translational Medicine. Unsurprisingly, several of the study authors hold patents for the therapy or have been paid by companies interested in providing it.

    The reporting in both The Times and The Daily Telegraph made it sound as if the treatment had been shown to work and was ready to be rolled out, when this is far from the case.

    The coverage in The Independent and Mail Online was more cautious, sticking mainly to the facts about the study.  

    What kind of research was this?

    This was a phase 1 dose-escalation safety trial. Phase 1 trials are designed to look at safety, not effectiveness.

    In this case, the trial was carried out to see whether patients with diabetes could tolerate the treatment without it causing severe side effects. Larger efficacy trials are done after safety trials to limit the number of people affected if they do find dangerous side effects.  

    What did the research involve?

    Researchers recruited 16 adults who had recently been diagnosed with type 1 diabetes and took a large sample of blood from them.

    They separated out the T-reg cells, removed defective cells, and treated the T-regs to expand their numbers. They then infused the T-reg cells back into the bloodstream, and followed these people up to see what happened.

    Two of the recruits did not have their cells transfused back into their bodies, as when researchers tested the samples, they failed to meet pre-set safety criteria. The researchers tested the function of the T-regs before they infused them back into the 14 remaining people. 

    The treatments were done in stages, one group of people at a time, with the first group receiving the smallest dose of T-regs. The researchers waited at least 13 weeks to see if anyone in the first group got serious side effects before moving on to give a bigger dose to the second group, and then repeating the process.

    People had weekly follow-up visits to check for side effects for the first four weeks, then every 13 weeks for the first year, with regular checks until five years after treatment. They also had a number of tests before and after treatment to see whether they were producing insulin.  

    What were the basic results?

    Nobody in the study had serious side effects the researchers thought had been caused by the treatment. This is important, because immune cell therapy could potentially cause problems, such as a severe reaction to the infusion.

    There is also the potential risk of a cytokine release, when T-cells produce proteins called cytokines that cause severe inflammation, similar to that of a bad infection.

    Nobody in the study had either of these problems, and none of the participants suffered from an increase in infections, which was also a potential side effect if there are more cells that dampen the immune response.

    The main adverse events experienced by people in the study were episodes of very high or very low blood sugar, which happens in people with diabetes when blood sugar is uncontrolled. The researchers say these were unlikely to be linked to the therapy.

    Follow-up studies showed some of the T-reg cells remained in the bloodstream for a year after infusion, although most of the cells (about 75%) could no longer be found 90 days after treatment.

    Studies of the treated T-regs in the laboratory, before they were infused back into people, showed the cells seemed to have recovered their ability to prevent the body from wrongly attacking beta cells. However, we don't know if this ability persisted after they had been injected.

    Tests of a protein called C-peptide, which can indicate whether people are producing insulin, showed a range of results. In some people, the levels remained about the same as before treatment, when you would normally expect them to decline over time.

    In other people, the levels of C-peptide dropped off to nearly zero after a year. The researchers say that, given the small numbers of people in the study and the fact they'd been treated at different times in the progression of the disease, it was impossible to tell whether the treatment had made any difference to these results.  

    How did the researchers interpret the results?

    The researchers concluded that their results "support the development of a phase 2 trial to test efficacy of the T-reg therapy".

    They say their therapy, when combined with other treatments being developed, "may lead to durable remission and tolerance in this disease setting".


    These early-stage results show work is underway to find a long-term treatment for type 1 diabetes, which could one day mean people do not have to inject insulin.

    However, that day is a long way off. Headlines suggesting an end to daily injections can unfairly raise people's hopes, leading to disappointment when no such treatment emerges.

    Bringing a new treatment into use requires at least three stages of trials, from the phase 1 safety trials, to phase 2 studies of efficacy, to larger-scale phase 3 clinical trials, where the treatment is given to large groups of people who may be followed-up for some time.

    This is usually done with a comparison group to see whether the new treatment performs better than placebo or the established treatment. Many treatments get no further than phase 1.

    The results from this study are encouraging for the researchers, as they allow them to move on to the next phase of study. However, it doesn't mean there are no safety concerns. 

    We need to see whether the treatment is safe and effective when given to large groups of people. Only after successful phase 3 trials can people with type 1 diabetes start to hope for an injection-free future.  

    Links To The Headlines

    Blood therapy heralds end of insulin jabs for diabetics. The Times, November 26 2015

    End of daily injections for diabetes as scientists restore insulin production. The Daily Telegraph, November 25 2015

    New treatment could free type-1 diabetics from 'daily grind' of insulin injections. The Independent, November 25 2015

    Could this be the end of daily injections for people with Type 1 diabetes? 'Game-changing' treatment restores production of insulin. Mail Online, November 26 2015

    Links To Science

    Bluestone JA, Buckner JH, Fitch M, et al. Type 1 diabetes immunotherapy using polyclonal regulatory T cells. Science Translational Medicine. Published online November 25 2015

  • Babies born on the weekend have slightly higher death risk

    "Babies delivered at the weekend are significantly more likely to die or suffer serious injury," the Daily Mail reports. 

    However, while the increase in risk is both significant and an obvious cause for concern, it should be noted that it is a very small increase.

    Researchers looked at the outcomes of 1,349,599 births in the two years from April 1 2010, and found that an estimated 770 extra deaths occurred each year above what would occur if all babies were born on weekdays.

    Obviously, 770 extra deaths is 770 too many, but it is important to put the figure into a larger context. When we look at the actual numbers, 0.73% of babies born at the weekend died, compared to 0.64% of babies born on weekdays.

    While it may be tempting to assume that the extra deaths are all down to staffing issues (e.g. consultants not working at weekends) other factors may be involved. For example, most women giving birth by planned caesarean section did so during the week. Babies born this way may be lower risk, which could make the weekday births appear safer.

    The study highlights that the overall risk of infant death is very low. However, the small difference in risk between those born on the weekend and on weekdays cannot be ignored.

    The study raises important questions about the provision of maternity services at weekends, and whether changes to staff availability and resources might reduce the numbers of deaths among babies born at the weekend.


    Where did the story come from?

    The study was carried out by researchers from Imperial College London and the National Audit Office, and was partially funded by Imperial College London’s research centre. The study was published in the peer-reviewed British Medical Journal (BMJ) on an open-access basis, which means it is free to read online.

    The tone of the reporting varied sharply between different media outlets. The Daily Mirror went with the powerful headline: "Betrayal of our babies as weekend births puts hundreds of mums and newborns at risk". The emotive headline was followed by a story that misreported the study’s figures. The report said that 770 babies delivered at the weekend die each year, when that is the estimated increased number of deaths each year, compared to if all babies were born during the week.

    The Guardian took a more measured approach, with "Weekend-born babies slightly more likely to die in their first week", and like most other media sources, reported the study accurately and with context.

    Unsurprisingly several sources, including the Daily Mail, The Daily Telegraph and BBC News, linked the study to the ongoing dispute between the government and junior doctors, over changes to doctors' contracts that would affect weekend working.

    The dispute was further inflamed by a recent controversial study, published in the BMJ in September, which estimated that there were an extra 11,000 "weekend deaths" during 2013-14. 

    However, the researchers themselves warned: "It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading".


    What kind of research was this?

    This is an observational study which used a database of NHS statistics to look for differences in outcomes between babies born during the week and at the weekend.

    Previous studies across various medical conditions have suggested that people admitted to hospital at the weekend have increased risk of death and other adverse outcomes, compared to if admitted on a weekday.

    This study aimed to see whether the association may also be found in maternity care. However, a study of this nature cannot say what has caused these differences.


    What did the research involve?

    The researchers used a large database of NHS statistics to find information about outcomes for women and babies in English maternity units.

    They looked at seven outcomes they said could be linked to quality of care, including overall infant mortality around the time of birth (including stillbirths and deaths within seven days), tears to women’s perineum (the area between the anus and the vulva), emergency re-admissions for mother or baby, and infections. They looked at rates of these outcomes on each day of the week, and compared weekend rates to overall weekday rates.

    The researchers chose Tuesday as a "reference day", because women admitted in labour on a Tuesday are likely to give birth during the week, and babies born on Tuesdays are not likely to have been born after a labour starting at the weekend. 

    They compared weekend outcomes to outcomes on a Tuesday, after taking account of a number of factors (confounders) that might have affected the results. These included the mother’s age, and the baby’s gestational age and birth weight. They then calculated how many extra deaths are likely to have occurred at the weekend, compared to if all births had the same risks as those happening on Tuesdays.

    A number of checks and adjustments to the figures were carried out to try to account for missing information and for other things that could have affected the results. They also looked to see whether maternity units which complied with recommendations about how many hours consultants should be present had better outcomes than units which did not comply with these recommendations.


    What were the basic results?

    Overall, 0.73% of babies born at the weekend died around the time of birth, compared with 0.64% of babies born during the week. In other words, this meant that babies born at weekends had a 7.3 in 1,000 chance of dying, compared to babies born during the week, who had a 6.4 in 1,000 chance. After taking account of factors that could explain the difference, this means that babies born at the weekend had a 7% greater chance of death (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02 to 1.13).

    Mothers had a 6% higher chance of getting an infection after giving birth if they were admitted at the weekend (95% CI 1.01 to 1.11), and babies had a 6% higher chance of being injured during birth if they were born at the weekend (95% CI 1.02 to 1.09). 

    There was a suggestion of a marginally increased chance of the baby being re-admitted as an emergency after a weekend birth, but this just fell short of statistical significance (OR 1.04, 95% CI 1.00 to 1.08). None of the other three outcomes measured showed a statistically significant difference between weekends and weekdays.

    Women giving birth in hospital units which met the Royal College of Obstetricians and Gynaecologists’ guidelines on consultant staffing levels were slightly less likely to have a perineal tear, but consultant levels showed no other differences in outcomes.


    How did the researchers interpret the results?

    The researchers said their study had shown that "performance across four of the seven measures was significantly worse for women admitted, and babies born, at the weekend". They highlighted the increase in stillbirths or deaths within seven days of birth as being of particular concern.

    They say that "further work is needed" to understand what lay behind their findings, and concluded: "Unless managers and practitioners work to better understand and tackle the problems raised in this paper, health outcomes for mothers and babies are likely to continue to be influenced by the day of delivery". 



    The media headlines resulting from this study sound alarming and could be worrying for pregnant women and their partners. However, there are some good reasons to be cautious.

    Firstly, it's important to keep in mind that it is unusual for babies to be stillborn or die within a few days of birth. It is devastating when it does happen, but the risk is low. In this study, this happened to around seven in every 1,000 babies born at the weekend and six in every 1,000 born on a weekday. Therefore, the absolute risk is very low, but the small difference in rates between weekends and weekdays cannot be ignored.  

    The biggest difficulty is that we don't know what is behind the increased chances of certain problems at the weekend. We cannot say it is simply because care is less good in hospitals than during the week.

    There are a number of important limitations to the study’s results. The database used, the Hospital Episode Statistics database, should include information about what happened to people from their admission to the maternity unit onwards. 

    However, the researchers found that much of the information they looked for was missing, including information about babies' birth weight (missing in almost 10% of cases) and whether they were born at full term (missing in 13% of cases). These are important factors that can affect whether a baby dies, and may have nothing to do with the care they receive during birth.

    The timing of admission and birth may also have affected the results. Babies were counted as having been born at the weekend if they were born between midnight on Friday and midnight on Sunday, although their mother may have been admitted in labour before then. Women were counted as having been admitted at the weekend if they were admitted between midnight on Friday and midnight on Sunday, although they may have given birth after then.

    This means that babies who died might have been classified as having been born at the weekend, even though the problems leading to their death might have happened during labour on the Friday.

    Conversely, mothers who had problems after being admitted at the weekend might not have encountered those problems until giving birth on the Monday.

    Although the researchers tried to make allowances for these issues, the amount of missing information from the database makes it harder to rely on the results.

    Another issue is the effect of planned caesarean births, which are almost always planned for a weekday.

    Professor Andrew Whitelaw, of the University of Bristol, said planned caesareans represented "low-risk babies" because there is almost no risk of the baby being starved of oxygen or physically injured during birth, and that the large numbers of planned caesareans during the week might lead to a reduced death rate on weekdays. 

    In an editorial published with the study, two professors of obstetrics and gynaecology from Oregon, in the US, conclude that "the most likely mechanism underlying the weekend effect is systems factors (such as staffing, resource availability, hospital policies)". This may be the answer, at least in part, as has been suggested with other areas of medical or surgical care. However likely this may be, the study does not provide evidence to prove this is the case. 

    The availability of consultants did not seem to make a big difference to the outcomes, although we don’t know whether the numbers of nurses, junior doctors and midwives available might have made a difference.

    Overall, this study raises a lot of questions about why certain outcomes, especially deaths of babies, were more common when babies were born at the weekend. We need more research to find out the answers.

    Links To The Headlines

    Risk of having a weekend baby: Major study reveals greater threat of stillbirth or death. Daily Mail, November 25 2015

    Babies born at weekends 'have higher death risk'. BBC News, November 25 2015

    Babies more likely to die if born in NHS hospitals at weekend. The Daily Telegraph, November 24 2015

    Babies born at weekends 'more likely' to be stillborn or die in first week of life. The Independent, November 24 2015

    Betrayal of our babies as weekend births puts hundreds of mums and newborns at risk. Daily Mirror, November 24 2015

    Weekend-born babies slightly more likely to die in their first week. The Guardian, November 24 2015

    Babies born in NHS hospitals at weekends 'have lower survival rate'. ITV News, November 25 2015

    Links To Science

    Palmer WL, Bottle A, Aylin P. Association between day of delivery and obstetric outcomes: observational study. BMJ. Published online November 24 2015

  • Loneliness 'may affect the immune system'

    "Being lonely won't just make you miserable; it could also suppress your immune system and knock years of your life," the Daily Mail reports. 

    This headline was prompted by a laboratory study in humans and rhesus macaque monkeys, which aimed to investigate if there were biological mechanisms associated with isolation that could also be associated with the risk of chronic disease or early death.

    The findings suggest increased activity of the sympathetic nervous system – responsible for the "fight or flight" response – may overstimulate development of inflammatory white blood cells in the bone marrow. At the same time it may decrease the production of antiviral proteins, reducing the body's ability to fight infections.

    However, at this stage this is still just a hypothesis. The study has not directly demonstrated that people who are socially isolated are more likely to become ill or die earlier and the immune system played a key role.

    Loneliness and social isolation can be complex emotions, and it may be difficult to pin down a single causative factor. It could be a cycle where people with a chronic disease may be less motivated to socialise with others, increasing the sense of isolation, and so on.

    Many people in the UK – particularly older adults – can be lonely and socially isolated. But there are ways to combat loneliness, both by seeking help if you are lonely and by helping lonely and isolated people in your community.   

    Where did the story come from?

    The study was carried out by researchers from the University of California and the University of Chicago, with financial support provided by the US National Institutes of Health.

    It was published in the peer-reviewed scientific journal PNAS on an open-access basis, so it is free to read online or download as a PDF.

    The UK media's reporting of the research was generally accurate, but could have benefited from making it clearer that we don't know whether these findings provide the whole answer.

    Also, although this study looks at a previously observed concept, it hasn't demonstrated that people who are lonely or isolated are more likely to become ill or die earlier.  

    What kind of research was this?

    This laboratory study in humans and rhesus macaque monkeys aimed to investigate the cellular effects of loneliness. Various studies have already linked social isolation in humans to chronic disease and mortality, though the possible biological mechanism behind this has remained poorly understood.

    In humans, feeling socially isolated can involve feeling threatened and being hyperalert. Humans evolved to live in groups with other humans, so prolonged isolation may, on an unconscious level, trigger feelings of profound unease about potential threats: if all of your tribe has suddenly vanished, you could be in a lot of trouble.

    Animal models have shown the response to a threat involves signalling from the sympathetic nervous system (SNS) – responsible for the "fight or flight" response – to the bone marrow, where new blood cells are produced.

    SNS signalling is thought to increase the activity of "pro-inflammatory" genes, which stimulate the development of early-stage myeloid blood cells in the bone marrow. These myeloid cells give rise to various types of white blood cells (involved in fighting infection), as well as red blood cells and platelets.

    It is thought increased myeloid stimulation could contribute to inflammation-related chronic diseases. Meanwhile, while increasing the activity of pro-inflammatory genes, SNS signalling is thought to decrease the activity of genes involved in the production of antiviral immune proteins.

    This process is called the conserved transcriptional response to adversity (CTRA) and is associated with specific gene activity, known as CTRA gene expression. This study aimed to find further evidence of the possible links between perceptions of social isolation and sympathetic nervous system effects on the myeloid cells and the CTRA.       

    What did the research involve?

    The research involved groups of humans and rhesus macaques, and looked at how perceived isolation was associated with measures of immune blood cells and CTRA gene expression.

    The human study involved 141 people taking part in the Chicago Health, Aging and Social Relations Study (CHASRS). About a quarter of these people perceived themselves to be highly socially isolated, based on their scores on a loneliness scale during the first five years of the study.

    The current research involved blood samples collected from these people during study years 5 to 10. The researchers looked at white blood cell count and CTRA gene expression. Urine samples were also collected to measure the "fight or flight" hormones adrenaline and noradrenaline, and the stress hormone cortisol.

    The researchers looked at the association between these biological measures and the score on the loneliness scale, taking account of various potential confounding factors, including age, gender, marital status, income and lifestyle factors.

    The macaques were classified to have low, intermediate or high social isolation based on their assessed sociability and behaviours that indicated they felt threatened. Researchers similarly took urine and blood samples from these animals examining stress hormones, white blood cells and gene expression. 

    What were the basic results?

    The researchers found people with perceived social isolation had an average 6.5% increase in the activity of genes making up the CTRA profile. After additional adjustment for stress, depression and level of social support, isolation was associated with a 12.2% increase in the activity of CTRA genes. Social isolation was also associated with increased levels of white blood cells involved in the inflammatory response.

    Similar results were found in macaques – those perceived as socially isolated demonstrated higher CTRA gene activity, with up-regulation of "pro-inflammatory" genes and down-regulation of genes involved in the production of antiviral immune proteins.

    This was also demonstrated as an impaired response when the macaques were experimentally infected with simian immunodeficiency virus (SIV), a type of virus that affects primates.

    Both humans and macaques with perceived social isolation also demonstrated increased urinary levels of the hormone noradrenaline. 

    How did the researchers interpret the results?

    The researchers concluded that their study shows socially isolated people have elevated sympathetic nervous system activity, which is associated with activation of the CTRA gene profile.

    This is characterised by up-regulation of pro-inflammatory genes and down-regulation of genes involved in the production of antiviral proteins.  


    People who are lonely and socially isolated have often been suggested as being at higher risk of illness, disease and early death. This study has aimed to further explore the possible biological mechanisms behind this.

    The findings suggest it may involve the "fight or flight" response overstimulating the development of inflammatory white blood cells in the bone marrow, while decreasing the production of antiviral proteins. The idea is this altered immune and inflammatory response could therefore contribute to the increased disease risk.

    But this is only a hypothesis. Though the research in animals has suggested socially isolated macaques may be more susceptible to viral infection, this study has not proved that socially isolated humans are more likely to become ill or die earlier.

    It also does not confirm this is the only biological mechanism by which social isolation may confer an increased disease risk in humans. Feelings of loneliness and social isolation can be complex emotions that may be influenced by many personal, health and life circumstances.

    For example, a person may have a chronic disease that has caused them to become more withdrawn, depressed and socially isolated. This chronic disease may then cause an increased mortality risk, rather than being a direct effect of the social isolation.

    As such, there may be several contributing factors involved in a cycle and it can be difficult to pin down a single causative factor – isolation, for example – directly leading to the outcome, such as disease or early death.

    However, what is fairly apparent from this and previous research is that, whatever the biological mechanism(s) that may be behind it, loneliness and social isolation do seem to be associated in some way with disease and illness.

    If you are feeling isolated and lonely, there are a range of organisations that can help you reconnect with peopleVolunteer work can also be an effective way of meeting new people, as well as boosting your self-esteem and wellbeing.

    Read more about how to combat feelings of loneliness.

    Links To The Headlines

    Loneliness is twice as bad as obesity for killing us early: Being isolated suppresses your immune system and knocks years off your life. Daily Mail, November 23 2015

    Loneliness triggers biological changes which cause illness and early death. The Daily Telegraph, November 23 2015

    Scientists reveal why being lonely increases your chances of dying early. Daily Mirror, November 23 2015

    Lonely people's white blood cells less suited to fighting infection, study says. The Independent, November 23 2015

    Death by loneliness: Isolation cutting short lives of millions. Daily Express, November 23 2015

    Links To Science

    Cole SW, Capitanio JP, Chun K, et al. Myeloid differentiation architecture of leukocyte transcriptome dynamics in perceived social isolation. PNAS. Published online November 23 2015

  • Has the 'happiness region' of the brain been discovered?

    "Neurologists 'work out the key to finding happiness'," claims The Independent. Japanese researchers claim to have found a link between reported happiness and an area of the brain called the precuneus.

    The researchers recruited 51 young adult volunteers, scanned their brain structure and probed their happiness and emotions using questionnaires.

    They found that more feelings of happiness were associated with a larger volume of the right precuneus. Other positive emotions and more purpose in life were also associated with greater volume in this region.

    Importantly, we don't know whether the findings in this small sample of Japanese people could be generalised to everyone. We also can’t apply cause and effect – that is, whether precuneus volume is set at birth and so predetermines our emotions, or whether it could change depending on our emotions.

    It is arguably simplistic to regard the brain as similar to the recent Disney film Inside Out – with specific regions of the brain linked to specific emotions such as joy, fear, anger, disgust and sadness.

    However, as the researchers discuss, the brain does have a high degree of plasticity – it is possible for brain cells to change and adapt through different types of activity and exposures. 

    Previous studies have indicated that meditation might increase the volume of the precuneus, and may be linked to happiness. There is a growing body of evidence that mindfulness-based techniques, such as meditation, can improve a person’s wellbeing. 

    Where did the story come from?

    The study was carried out by researchers from Kyoto University and other research institutes in Japan. It was funded by the Japan Society for the Promotion of Science – Funding Program for Next Generation.

    The study was published in the peer-reviewed scientific journal Scientific Reports on an open-access basis, so it is free to read online or download as a PDF.

    The media has generally taken these findings at face value, and could benefit from acknowledging the limitations of this cross-sectional study of a small and select population sample.

    The Independent's headline "Neurologists 'work out the key to finding happiness'," is unsupported by the facts presented in the study.

    The Daily Telegraph wrote: "Meditation increases the grey matter in a part of the brain which is linked to happiness, scientists have found," which implies this is one of the new findings the study produced. It was not.

    The Telegraph wasn't alone in making this subtle mistake. The study referenced another study, which they said showed that this brain region structure could be changed through training, such as meditation, but they did not investigate or confirm this themselves.

    A recent meta-analysis into whether meditation could change brain structure had mixed results. While the researchers did find some positive results, they also cited concerns about "publication bias and methodological limitations".


    What kind of research was this?

    This was a cross-sectional study which aimed to investigate whether subjective happiness is associated with specific brain features.

    As the researchers say, happiness is a subjective experience that is important to humans, even to the extent that many philosophers and scholars have called it "the ultimate goal in life".

    Previous studies have suggested that happiness has a strong hereditary component, and involves cognitive (mental processes of perception, memory, judgement, and reasoning) as well as emotional components. However, actual structural brain features associated with this feeling have remained elusive.    

    This study aimed to look at participants' brain structure on MRI scanners to see how this was associated with measures of reported subjective happiness and other emotions. 


    What did the research involve?

    The research included 51 volunteers (average age 23) who had MRI scans and completed various psychological questionnaires assessing their feelings.

    Subjective happiness was measured on a four-item Subjective Happiness Scale, positive and negative feelings on an Emotional Intensity Scale, anxiety on a State-Trait Anxiety Inventory, and other thoughts surrounding happiness on a Purpose in Life Scale.

    All four of these questionnaires were Japanese versions, which have been validated for use in Japanese people.

    The participants had MRI scans, and the researchers looked at the association between brain imaging findings and subjective happiness score, taking into account the influence of scores on the other scales. 


    What were the basic results?

    Looking at the different psychological questionnaires, the researchers found that, unsurprisingly, greater subjective happiness was associated with positive emotions and higher purpose in life scores. Conversely, negative emotions and higher trait anxiety were associated with lower happiness scores.

    Looking at the MRI scans, subjective happiness was linked to volume of the right precuneus, an area of the brain previously associated with feelings of ego or self-consciousness. Happiness score was not associated with any other brain region.

    The researchers also found that right precuneus volume was associated with feelings on the other scales. Positive emotions and more purpose in life were associated with greater volume, negative feelings with lower volume.


    How did the researchers interpret the results?

    The researchers conclude that they have found a positive association between subjective happiness score and volume of the right precuneus in the brain – a brain region also associated with emotional and purpose of life scores. 

    They suggest that, "the precuneus mediates subjective happiness by integrating the emotional and cognitive components of happiness".



    This Japanese study found subjective happiness to be associated with volume of one brain region – the right precuneus. Previous research is said not to have been able to clarify whether brain features are linked to this elusive and highly valued feeling.

    Perhaps unsurprisingly, the researchers also found that greater subjective happiness was associated with positive emotions and greater feelings of purpose in life, while lower happiness was linked with the opposite. 

    There is however, little else to be concluded from this research and there are a few important limitations to note.

    The sample size, at only 51, was small for this type of study. The participants were also all young Japanese adults. Great care must be taken before extending the observations in this sample to people of other populations, or all people in general. The same findings may not have been observed in another group of people.

    The study is cross-sectional, taking one-off psychological questionnaires and one-off brain scans. We do not know whether the psychological assessments reflect lifelong happiness, mood or emotions in these people, or whether these are more transitory states – as they can be for many of us – depending on current life circumstances. We also don't know whether the questionnaires are able to grasp all the nuances of people's feelings.

    Being cross-sectional, we also can't conclude on cause and effect. We don't know whether the feelings or emotions of an individual could be predetermined by the precuneus volume they are born with, or whether brain nerve cells in this area could change and adapt during life – influencing volume – depending on our feelings and emotions.

    The researchers do discuss two previous studies. One suggests that meditation can increase happiness, while a second suggests that psychological training, such as meditation, could influence the volume of the precuneus. However, they did not study whether this was true themselves – it was just part of their discussion about the potential implications of their research.

    Randomised controlled trials or carefully designed observational follow-up studies would be needed to better assess whether mediation or other psychological practices could influence our brain or emotions.  

    This study alone provides no evidence that mediating will influence our brain structure or volume and make us feel happier.

    That said, the concept of "mindfulness" – using a range of techniques, including meditation, to become more aware of the world around you – has become increasingly popular. Supporters of mindfulness claim that it can help combat stress and improve wellbeing. 

    Links To The Headlines

    Neurologists 'work out the key to finding happiness'. The Independent, November 21 2015

    Grow your own happiness: how meditation physically changes the brain. The Daily Telegraph, November 20 2015

    Is the search for happiness over? Experts discover the part of the brain that determines how cheerful we are. Mail Online, November 21 2015

    Links To Science

    Sato W, Kochiyama T, Uono S, et al. The structural neural substrate of subjective happiness. Scientific Reports. Published online November 20 2015

  • One diet 'doesn’t fit all' – people 'metabolise food differently'

    "No one diet fits all," the Daily Mail reports. 

    Israeli researchers monitored 800 adults to measure what is known as postprandial glycemic response – the amount by which blood sugar levels increase after a person eats a meal. This measure provides a good estimate of the amount of energy that a person "receives" from food.

    The researchers found high variability in postprandial glycemic response across individuals who consumed the same meals.

    They found these differences were related to the individual's characteristics, and developed a model (known as a "machine learning algorithm") to predict an individual's response to a given meal.

    When 12 individuals were put on two different tailored meal regimens predicted by this model to either give lower blood sugar levels or higher levels for a week each, the prediction was correct in most of the individuals (10 of the 12).

    Results of the study should be interpreted with some caution due to limitations. The main one is that the sample in which the diets were tested was small, with a short follow-up period. The study looked at post-meal blood sugar levels and not weight, so we cannot say what the impact on weight would be.

    Still, the concept that a machine learning algorithm model could be used to create a personalised diet plan is an intriguing idea. In the same way Netflix and Amazon "learn" about your TV viewing preferences, the plan could "learn" what foods were ideally suited to your metabolism.  

    Where did the story come from?

    The study was carried out by researchers from the Weizmann Institute of Science, Tel Aviv Sourasky Medical Center and Jerusalem Center for Mental Health – all in Israel. 

    The study was funded by Weizmann Institute of Science, and the researchers were supported by various different institutions, such as the Israeli Ministry of Science, Technology and Space.

    The study was published in the peer-reviewed scientific journal Cell.

    The Daily Mail's reporting implies the study explains why different weight loss diets perform differently in different individuals, but we cannot say this based on the research. 

    The study only aimed to look at blood sugar levels after a meal – not weight. It also did not compare the personalised dietary plans the researchers developed against popular weight loss diet plans such as the 5:2 diet.


    What kind of research was this?

    This study aimed to measure the differences in post-meal blood glucose levels between individuals and to identify personal characteristics that can predict these differences.

    The researchers then used a small randomised controlled trial (RCT) to identify whether personalising meals based on this information could help reduce post-meal blood glucose levels.

    Researchers say that blood sugar levels are rapidly increasing in the population. This has led to an increase in the proportion of people with "pre-diabetes" where a person has higher blood sugar than normal, but does not meet all of the criteria required for being diagnosed with diabetes. They say that up to 70% of people with pre-diabetes eventually develop type 2 diabetes.

    Having high blood sugar levels after meals is reported to be linked to an increased risk of type 2 diabetes as well as obesityheart disease and liver disease

    The researchers hoped that by understanding the factors responsible for variations in post-meal blood glucose levels they could use this information to personalise dietary intake to reduce those levels.


    What did the research involve?

    Stage I

    This study started with 800 healthy and pre-diabetic individuals (aged 18-70 years). The cohort was representative of the individuals without diabetes in Israel. Just over half (54%) of the cohort was overweight and 22% were obese.

    Researchers started by collecting data on food intake, lifestyle, medical background and anthropometric measurements (such as height and weight) for all the study participants. A series of blood tests was carried out and a stool sample (used to assess gut microbial profile) was also collected.

    Participants were then connected to a continuous glucose monitor (CGM) over seven days. The machine was placed on the individual's skin to measure glucose in interstitial fluid – the fluid in and around the body's cells – every five minutes for a week. They were also asked to accurately record their food intake, exercise and sleep using a smartphone-adjusted website developed by the researchers.

    Over this period, the first meal of each day was a standardised meal given to all participants to see how their blood glucose responses differed. Other than that, they ate their normal diets.

    Researchers then analysed the relationship between an individual's characteristics and their post-meal glucose levels. They developed a model based on these characteristics that would predict what these levels would be. They then tested their model on 100 other adults.

    Stage II

    To assess whether personally tailored dietary interventions could improve post-meal blood sugar levels, researchers carried out a randomised crossover trial

    This trial included 26 new participants who were connected to continuous glucose monitors (CGM) and had the same information collected as the 800-person cohort over a week. This allowed the researchers to identify their personal characteristics and blood glucose responses to meals.

    After this, the groups were allocated to two different personalised diets. One group (the "prediction" group) was allocated to receive a meal plan based on what the researchers' model predicted to be a "good" or a "bad" diet for them. They received these two different meal regimens for a week each, in random order:

    • one regimen was based on meals that were predicted to produce "low" post-meal blood sugar levels (good diet) in the individual
    • one regimen was based on meals predicted to produce "high" post-meal blood sugar levels (bad diet) in the individual

    The second group (the "expert" group) took part in a similar process, but their "good" and "bad" diets were based on what a clinical dietitian and researcher selected for them based on looking at the person's responses to different meals in the first week of the study.

    Participants and researchers did not know which meal plan they were eating during the study – so both groups were blinded.


    What were the basic results?

    Overall, the study found high variability in post-meal blood sugar levels across the 800 individuals even when they consumed the same meal. They found that many personal characteristics were associated with their post-meal blood glucose levels, including their body mass index (BMI) and blood pressure, as well as what the meal itself contained.

    One example, given in an interview to the Mail, was the case of a woman whose blood sugar levels spiked dramatically after eating tomatoes.

    The researchers developed a model based on these characteristics to predict their glucose levels after a meal. This model was better at predicting post-meal glucose levels than simply looking at how much carbohydrate or calories the meal contained. The model performed similarly well when tested in a different group of 100 adults.

    The researchers found that most of the individuals on the "prediction" diet (10 out of 12; 83%) had higher post-meal blood glucose levels during their "bad" diet week than their "good" diet week. This was slightly better than the "expert" diet – where eight out of 14 participants (57%) had higher post-meal blood glucose levels during their "bad" diet week.


    How did the researchers interpret the results?

    Researchers concluded that this research suggests: "personalised diets [including the one based on their algorithm] may successfully modify elevated postprandial blood glucose and its metabolic consequences".



    This study assessed the differences in post-meal blood sugar levels – medically known as postprandial glycemic responses (PPGR) – across 800 non-diabetic adults, and found a lot of variation between individuals. 

    They developed a model based on a wide range of personal characteristics, such as a person's BMI and gut microbial profile, which could predict their response to a given meal.

    In a small crossover study, it found that tailoring meals for individuals based on their model could help lower the individual's post-meal sugar levels.

    This study has some strengths and limitations. Its strengths include the relatively large sample size used to analyse the relationship between personal characteristics and post-meal blood sugar levels, and the fact the model they developed was then checked in a new group of individuals.

    The main limitation of this study is that the actual testing of the personalised diets was done in a small sample of only 26 people, with only 12 of these getting the diet based on the model's predictions.

    What we can say based on these results is also limited based on its short follow-up period and the fact that only blood glucose levels were measured. We cannot say what effects these different diets have on a person's weight or risk of diabetes in the long term.

    It appears the research team is now looking into finding commercial applications for this approach. It would be feasible to combine a continuous glucose monitor with a smartphone application that creates a personalised diet plan. If successful, such an application would likely become very popular.

    Links To The Headlines

    No ONE diet fits all: How your body reacts to Atkins, Paleo and the 5:2 'is determined by your metabolism'. Daily Mail, November 20 2015

    Expert diet tips could be WRONG as we all metabolise food in different ways. Daily Mirror, November 19 2015

    Links To Science

    Zeevi D, Korem T, Zmora N, et al. Personalized Nutrition by Prediction of Glycemic Responses. Cell. Published online November 19 2015