Methane-producing microorganism makes a meal of iron

A new understanding of how an important methane-producing microorganism creates methane and carbon dioxide could eventually allow researchers to manipulate how much of these important greenhouse gases escape into the atmosphere. A new study by Penn State researchers proposes an updated biochemical pathway that explains how the microorganism uses iron to more efficiently capture energy when producing methane. The study appears online in the journal Science Advances.

“The microorganism Methanosarcina acetivorans is a methanogen that plays an important part in the carbon cycle, by which dead plant material is recycled back into carbon dioxide that then generates new plant material by photosynthesis,” said James Ferry, Stanley Person Professor of Biochemistry and Molecular Biology at Penn State, who led the research team. “Methanogens produce about 1 billion metric tons of methane annually, which plays a critical role in climate change. Understanding the process by which this microorganism produces methane is important for predicting future climate change and for potentially manipulating how much of this greenhouse gas the organism releases.”

Methanosarcina acetivorans, which is found in environments like the ocean floor and rice paddies where it helps to decompose dead plant material, converts acetic acid into methane and carbon dioxide. Prior to this study, however, researchers were not certain how the microorganism had enough energy to survive in the oxygen-free — anaerobic — environments where it lives. The researchers determined that an oxidized form of iron called “iron three,” essentially rust, allows the microorganism to work more efficiently, using more acetic acid, creating more methane, and creating more ATP — a chemical that provides energy for biological reactions essential for growth.

“Most organisms like humans use a process called respiration to create ATP, but this requires oxygen,” said Ferry. “When no oxygen is present, many organisms instead use a less efficient process called fermentation to create ATP, like the processes used by yeast in the production of wine and beer. But the presence of iron allows M. acetivorans to use respiration even in the absence of oxygen.”

The findings allowed the researchers to update the biological pathway by which M. acetivorans converts acetic acid to methane, which now includes respiration. Pathways like this one involve many intermediate steps, during which energy is often lost in the form of heat. The researchers also determined that in the presence of iron, energy loss in this microorganism is reduced due to a recently discovered process called electron bifurcation.

“Electron bifurcation takes one of those steps that has the potential for tremendous heat loss and harvests that energy in the form of ATP rather than heat,” said Ferry. “This makes the process more efficient.”

This updated pathway could allow researchers to predict the amount of methane that the microorganism will release into the atmosphere.

“Rice paddies — a major source of the methane in the atmosphere — contain decaying rice plants submerged in water that are ultimately processed by M. acetivorans. If we measure the amount of iron three present in the paddies, we can predict how much methane will be released by the microorganisms, which can improve our climate change models.”

In the absence of iron, the microorganism produces roughly equal amounts of methane and carbon dioxide from acetic acid. But with increasing amounts of iron, it produces more carbon dioxide relative to methane, so providing the organism with additional iron could alter the relative amounts of these greenhouse gasses that are produced.

“Methane is 30 times more potent as a greenhouse gas than carbon dioxide, which makes it more problematic in terms of our warming planet,” said Ferry. “Now that we better understand this biochemical pathway, we see that we can use iron to alter the ratios of the gasses being produced. In the future, we might even be able to go further and inhibit the production of methane by this microorganism.

“In addition to the practical applications, this is a major addition to understanding the biology of the largely unseen but hugely important anaerobic world.”

In addition to Ferry, the research team includes Divya Prakash and Shikha Chauhan at Penn State. The research was supported by US Department of Energy and the Penn State Eberly College of Science.

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Materials provided by Penn State. Note: Content may be edited for style and length.

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Genome mining reveals novel production pathway for promising malaria treatment

Microbes are well-known among biologists as master engineers of useful small molecules, and there are many tricks of their trade. When researchers at the University of Illinois took a closer look at how a known microbe makes a known so-called natural product, they were rewarded with the discovery of a completely unknown biochemical trick.

G. William Arends Professor of Molecular and Cellular Biology at the University of Illinois William Metcalf led the study with then-postdoctoral researcher Elizabeth (Betsy) Parkinson. Parkinson is now an assistant professor of chemistry at Purdue University. Metcalf, Parkinson and coauthors reported their work, which was supported by NIH, in Nature Chemical Biology.

The work began with a surprise: the researchers set out to explore how their microbe of interest, Streptomyces lavendulae, creates a chemical called fosmidomycin. The team was interested in how this compound is created in part because it’s an antimicrobial that is effective against malaria, a mosquito-borne illness that kills hundreds of thousands of people each year. As expected, S. lavendulae did produce a compound that killed microbes — but it wasn’t fosmidomycin.

“The most interesting stuff research is where you ask a question and you get a completely unexpected answer,” Metcalf said. “Something turn out as we expected; that’s great!”

More surprises quickly followed. The team traced the bacterium’s killing powers to production of a closely related molecule, dehydrofosmidomycin, a known natural product that may even be slightly better than fosmidomycin for treating malaria. However, the genes that S. lavendulae was using to make dehydrofosmidomycin were completely unlike those seen in other microbes.

“It’s very similar to another class of molecule that we’ve worked on in the past, virtually identically, chemically and structurally, but the biosynthetic pathway and the genes are completely different,” Metcalf said. “Which if you think about evolution and how you got there, that’s fascinating, that these molecules are so good that nature independently discovered it multiple times.”

Microbes evolve the capability to make natural products like fosmidomycin and dehydrofosmidomycin to help them outcompete neighboring microbes for space and resources. Each natural product is chemically crafted by a series of proteins called enzymes, which take turns tweaking the growing molecule by adding or removing atoms to change its shape and activity. Microbial genomes are scattered with clusters of genes encoding these enzymes, with one cluster typically containing all the genes necessary for making one natural product.

Metcalf’s laboratory and other researchers at the Carl R. Woese Institute for Genomic Biology at the University of Illinois want to explore the relationship between microbial natural products and the gene clusters that enable their production. By learning to recognize what genes lead to what types of products, they hope to use genome sequencing to speed discovery of new natural products that, like fosmidomycin and related molecules, may have key therapeutic properties.

Metcalf was particularly excited to see a familiar type of molecule being made by an unfamiliar gene cluster.

“The technical term is convergent evolution towards a chemical product,” Metcalf said. “And that tells you . . . that it’s a really good molecule. It does what nature wants it to do: it’s an antibacterial and it also kills parasites, like malaria and plants, like weeds, it’s really got a lot of uses. It’s utterly non-toxic to human beings, which is nice.”

The researchers delved deeper into the details of the new gene cluster and the chemical reactions facilitated by its enzymes. They reconstructed and experimentally confirmed a series of steps leading from the starting “ingredients” to the finished product.

“So why do you care about how molecules like this are made? . . . A really good bioengineered pathway, it’s the cheapest way to make anything,” Metcalf said. “This offers another route to the same molecule, which might be a more efficient route, might be a cheaper route, that has yet to be explored.”

The highlight of the newly discovered pathway was an enzyme encoded by the gene dfmD. Its name, reminiscent of a library call number and chosen by the researchers to indicate its position in the dehydrofosmidomycin-producing gene cluster, belies the novelty of the chemical reaction the enzyme facilitates.

“You break two carbon-nitrogen bonds, you reform one carbon-carbon bond, and you oxidize another carbon-carbon bond. And you do that all in one step,” Metcalf said. In other words, the enzyme breaks a piece off the larger molecule, flips it around, reattaches it, and tweaks the resulting product, all in the single continuous action, analogous to a person changing seat configurations in a minivan commercial.

“In simplest terms, what dfmD is doing is a chemical reaction that’s not easy to envision, number one, just based on first principles of chemistry; and number two, that’s never been observed in nature before,” Metcalf said. “Because this is doing something radically different, it adds to that body of knowledge so that when we look at new pathways, we can think about how they might work.”

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5 Mental Tricks to Feeling Amazing, Even if You Miss a Few Workouts

Your plan was to relaunch your regular gym and clean eating regimen on Monday. After a few weeks of solid effort, that's mostly fallen by the wayside. Logically, you know that your self-worth doesn't rely on perfect attendance at SoulCycle. So why do so many of us drop into a shame spiral when we skip a few workouts or finish off a sugary treat? 

"We’re in a society that hyper-values fitness and thinness, and we're taught to be ashamed of feeling like we're not to living up to expectation," says Andrew Walen, a psychotherapist specializing in eating disorders and body image and the founder of The Body Image Therapy Center in Washington, D.C. Not sticking to a routine can also make you feel out of control, and that too tends to fuel anxious or depressive thinking, says Walen.

RELATED:  8 Empowering Life Lessons I Wish Every Woman Knew

Maintaining your healthy food and fitness goals is hard work, and sometimes life gets in the way—or the couch and a Stranger Things binge session are calling you hard. Next time you start to feel guilty for what you view as slipping up, try these simple mental tricks, which will banish negative thoughts and empower you with body positivity.

Recite a mantra

Repeating an affirmation, song lyric, or some other catchy and motivational phrase might sound a little silly. But reciting inspiring words keeps you in the moment and gives your brain something to focus on, crowding out self-criticism while the mantra's positive message sinks in, says Walen. 

Next time you start to beat yourself up for ditching the treadmill, repeat your mantra out loud or in your head with intention. We like "I'm more than my body" and "I am beautiful" because these phrases are simple and super upbeat. But anything that resonates with you in a personal way will work just fine.

RELATED: 5 Powerful Mantras to Help You Quiet Anxiety, Beat Self-Doubt, Manage Stress, and More

Banish 'I should' from your brain

Pay attention to key words in your own internal dialogue. "Every time you hear 'I should' or 'I must,' recognize that you're punishing yourself for no reason," says Walen. For example, if you're spending time relaxing on the couch with family and suddenly catch yourself thinking, "I really should put on my gym gear and go for a run," stop right there. Distract yourself with your social feed, a conversation with your partner, anything to get out of that negative head space.

Put on clothes that make you feel awesome

You should never feel bad about your body, but if you do, there's no quicker way to start feeling sexy and attractive than changing into an outfit you know you look good in. "Dress in a way that makes you feel adventurous and flirtatious and desirable," says Walen. "Don’t feel like you need to fit into a mold with what you wear—it’s a time to express yourself." Whether it's a revealing bandage dress or comfy jeans and sneakers, your clothes can switch up your mindset.

RELATED: 9 Easy Ways to Practice Self Care This Week

Don't get sucked into someone else's body criticism

Body shame is so prevalent in our culture, you might frequently find yourself caught up in other people's body drama—such as a conversation about your sister's failing efforts to stay on Whole30 or your coworker's guilt about gaining a few pounds. Before their body negativity triggers your own dissatisfaction, change the subject, suggests Walen.

If redirecting the conversation isn't your cup of tea, just leave the vicinity. Politely excuse yourself and spend time with people who are talking about something besides diet and exercise.

RELATED: Is Facebook Messing With Your Self-Esteem? Ask Yourself These 3 Questions

Be kind and forgiving—to yourself

When we feel guilty for not living up to our own (our society's) expectations, we tend to punish ourselves for it—vowing to skip a meal to make up for a binge, for example, or overexerting ourselves at the gym to compensate for blowing it off all week. Problem is, doing this treats food and fitness as punishments, when they should be celebrations of your body and mind. So give yourself permission to make mistakes and enjoy life's indulgences, with no regrets whatsoever.

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This 37-Year-Old Woman Got Toxic Shock Syndrome From a Rug Burn on Her Arm—and Almost Died

On a June day in 2015, Alecia Kennen was going about her routine when she accidentally tripped over the family dog. Her right shoulder broke the fall, and she ended up with a pretty standard case of rug burn—at least that's what she assumed at first.

"I never thought that it could turn into what it did," Kennen, 37, tells Health. 

A few days later, Kennen felt an unusual pain under her right armpit, she says. She went to work and tried to brush it off, but halfway through the day, the pain had gotten so bad that she knew she had to get to the hospital. 

She saw multiple doctors near her home in Wisconsin over the next few days, but none of them could figure out what was wrong. In addition to the unbearable pain, she had a fever, aches, nausea, and she was starting to feel delirious. "It was like the pain was so bad that I couldn't focus on anything else," she says. 

It wasn't until she returned to the ER three days after the pain began that doctors recognized this was an emergency. 

RELATED: My Daughter Nearly Died of Sepsis. Here's How You Can Stay Safe


Facebook/Alecia Kennen

Kennen was immediately taken by helicopter to Sacred Heart Hospital in Eau Claire, Wisconsin, where her symptoms continued to worsen. She was bleeding internally, her lungs had filled with fluid, and she was going into multi-organ shut down. Kennen says after many tests, the doctors, who were at a loss, told her family that she was losing the battle with this mystery illness, and that it was time for them to say goodbye. 

Around the same time, the doctors found out Kennen's sons had been complaining of sore throats. They tested them for strep, and all three came back positive. "It was the hint the doctors needed," Kennen says. 

Kennen was diagnosed with group A Streptococcus toxic shock syndrome (TSS) shortly after. TSS is a rare, potentially deadly complication of certain bacterial infections, like group A strep. Most know TSS because you can get it from leaving a tampon in for too long (a highly-absorbent tampon left in the body for long periods of time can create the right environment for rapid growth of bacteria). But the bacteria can also enter the body through cuts and scrapes, like Kennen's rug burn. (The doctors couldn't know for sure that it entered through the rug burn, Kennen says, but they didn't see how else the bacteria could have gotten into her bloodstream.)

By the time she was diagnosed, her fingers and toes had started to turn black due to a lack of blood flow and oxygen reaching her extremities. She was rapidly declining. Kennen was airlifted to UW Health University Hospital in Madison, Wisconsin, where she remained for treatment for the next few weeks.

Doctors performed blood transfusions, as well as dialysis to keep her kidneys functioning. They also had to amputate all of Kennen's fingertips at the knuckle because the tissue was necrotic, or dead. She was finally discharged in August 2015, about two months after she first went to the hospital.

RELATED: I Thought I Had the Flu—but It Turned Out to Be Sepsis

But that wasn't the end of Kennen's battle—the infection ended up recurring multiple times.

In January 2016, the infection came back in Kennen's right foot, and doctors had to amputate her toes. Then, in June of this year, it came back in her foot once again, and doctors amputated her right leg below the knee. She explains that the recurrences have been more mild than the first time, presenting with common symptoms of infection, such as swelling, heat, and redness in the affected area. The amputations, however, have been life-changing. 

"I've been pretty much wheelchair bound, which makes it difficult to take care of my children," she says. "I've had to learn completely new ways of doing things. Everything I do, even if it's a simple task, takes twice as long. I'm really hoping that this will be the last of it and that I can get back to living somewhat of a normal life." 

Kennen had to leave her job as a legal assistant when she first got the infection in 2015. In the four years since, she says there was just one stint of about nine months where she was well enough to work. She's hoping she'll be able to go back for longer, ideally indefinitely, when she's fully recovered from her most recent amputation. 

Fortunately, she's had her three boys, as well as a network of family and friends, to support her through these trying times. "My boys are definitely the reason that I've tried to live every day since to the fullest," she says. "I've been blessed by my family, my friends, the community. My support system has been key." 

Kennen says she's sharing her story to alert people to the dangers of TSS and to the possibility of developing it from things other than tampon use. "You get a rug burn, you get a small cut, and you never think it's something that could end your life in days," she says. "I just want people to know that it can happen, and to know the signs and the symptoms, because I didn't, and I wish I would've had a better understanding that things like this are rare but they can happen."

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Health24.com | Could health warnings printed on individual cigarettes help people quit smoking?

There are many reasons people want to quit smoking. Whether it’s digging a hole in your pocket, or if you’re worried about the harmful effects, kicking the habit can be very difficult.

A wide variety of methods are available if you want to quit, but researchers found that health warnings printed on individual cigarettes may be especially effective in helping people to quit. 

A greater impact

The paper, published in Addiction Research was written by experts from the University of Sterling’s Social Media Marketing team. They examined the perception of smokers seeing the “Smoking Kills” warning on individual cigarettes, compared to the same message only appearing on packs.

120 smokers from Glasgow 16 and older were put into 20 focus groups. In every group, most participants felt that warnings on individual cigarettes would have a greater impact on them and other smokers.

Smokers felt that this new approach could potentially discourage smoking among younger individuals, those who only recently started smoking, as well as non-smokers. Some of the participants felt that a warning on each individual cigarette would emphasise the message over a longer period of time, due to the fact that it becomes visible every time someone takes a cigarette out of a pack, leaves it in an ashtray or takes a puff.

The fact that the warning was more visible to participants was reported to be off-putting because it constantly brought up negative images. Especially females perceived the warnings as depressing, frightening and worrying.

Off-putting for young people

The warnings form part of the Scottish Government’s tobacco-control action plan, which aims to raise a “tobacco-free generation”. As part of the initiative, they want to make changes to the “colour, composition and/or warning messages on each stick”.

Dr Crawford Moodie, lead researcher in the study, said, “The consensus was that individual cigarettes emblazoned with warnings would definitely be off-putting for young people, those starting to smoke and non-smokers.” Furthermore, “This study suggests that the introduction of such warnings could impact the decision-making of these groups. It shows that this approach is a viable policy option and one which would – for the first time – extend health messaging to the consumption experience.”

Cancer Research UK’s prevention expert, Professor Linda Bauld, said, “Too many young people are still taking up smoking. Government anti-smoking campaigns and tax rises on cigarettes remain the most effective methods to stop young people starting smoking, but we need to continue to explore innovative ways to deter them from using cigarettes to ensure that youth smoking rates continue to drop.”

The study also showed that using tactic such as making cigarettes unappealing could prove to be an effective method to help people quit smoking, or not start at all.

Image credit: iStock

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Health24.com | Teen who went blind after living off chips, white bread, processed meat: His weight was normal and masked rare eye condition

A new case report suggests it’s possible for a steady diet of junk food to rob you of your vision: After years of eating only potato chips, French fries, cold cuts and white bread, a 17-year-old British boy went blind.

Despite his bad eating habits, his body mass index, a standard measure of obesity, remained normal. But the lack of essential vitamins and minerals took its toll. Anaemia set in, his bone mineral density plummeted, and his levels of vitamin B-12, vitamin D, copper and selenium all cratered.

That triggered “nutritional optic neuropathy”, the investigators said, a rare form of optic nerve damage more common in food-starved developing nations. If left untreated, it can lead to permanent vision loss.

“It is not that the junk food had a toxic effect on his vision, but that he wasn’t eating nutritious and varied foods,” explained study author Denize Atan. She is a consultant senior lecturer with Bristol Medical School at the University of Bristol.

Height and weight stayed normal

A picky eater since about the age of 11, the boy purposely avoided certain food textures, subsisting entirely on processed carbs, ham slices and sausage.

“Most of his diet was fat and carbohydrate, which contain a lot of calories,” Atan said. That meant his height and weight stayed normal, masking his condition, even as his nutrient intake steadily dwindled.

And that’s a problem, she said, because “there are multiple vitamins and minerals that are important for eye health”.

Those include vitamin A, vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B6 (pyridoxine), vitamin B9 (folate), vitamin B12 (cobalamin), iron, calcium, magnesium, and copper.

“Perhaps if he’d only eaten fish and vegetables, he wouldn’t have run into problems,” Atan added. But as things stood, by age 14 the teen developed chronic fatigue, hearing loss and vision problems. By 17, nutritional optic neuropathy had taken hold, stealing most of his central “reading” vision.

The patient’s peripheral “navigation” vision remained intact. And vitamin replacement treatment did restore some color vision loss, said Atan. But the damage to the boy’s optic nerves was largely irreversible.

A bit shocking

Lona Sandon is programme director of the department of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas. “To get this nutrient-deficient to cause optic neuropathy is a bit shocking,” she said.

“Unfortunately, poor diet quality is way too common among kids and adults,” Sandon acknowledged. “Heavy reliance on pre-prepared foods and fast foods is very common. I hear stories frequently from parents that all they can get their kids to eat is chicken nuggets.”

But while many teens go through a picky-eating phase, Sandon stressed that restricting one’s diet to just a handful of foods for many years “is not normal”.

So what explains it? Sometimes the pattern develops among kids with food allergies or those with autism, Sandon said.

Introduce a range of foods

But Atan pointed out that some very picky eaters actually suffer from a mental health condition known as “avoidant restrictive food intake disorder”. Typified by a lack of interest in food, heightened sensitivity to food textures and a fear of eating, the disorder can prompt significant weight loss, nutritional deficiencies and impaired social functioning.

It’s unclear if the British teen suffered from this condition. But Atan stressed that even after losing vision, the boy’s diet has remained “quite entrenched”.

“He now takes multivitamin supplements,” she noted, “but I cannot say that his eating behaviour has changed much, despite seeing gastroenterologists, dietitians, the child mental health team and eating disorder specialists.”

So what’s a concerned parent to do? In general, “parental anxiety about picky eating is more likely to perpetuate the behavior in their children”, Atan cautioned. “It is better to introduce a range of foods to our children, and not give in to, or worry about, the pickiness.”

And Sandon offered this advice: “Make an appointment with a registered dietitian nutritionist who specialises in pediatrics, to assess your child’s growth and development, and his/her diet for potential nutrient deficiencies. And assess risk factors for disordered eating that might signal other concerns.”

The report was published online September 3 in the Annals of Internal Medicine.

Image credit: iStock

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Health24.com | Speed up stroke recovery with exercise

Aerobic exercise significantly improves stroke survivors’ endurance and walking ability, researchers report.

They analysed 19 studies that included nearly 500 stroke survivors, aged 54 to 71, who completed aerobic exercise programmes similar in structure to cardiac rehabilitation.

Significant improvements

The patients did two or three aerobics workouts a week for about three months. Walking was the most common type of activity, followed by stationary cycling and mixed aerobic exercise. The patients’ endurance and walking speed were tested before and after they completed the programmes.

Overall, the patients had significant improvements. After completing the therapy, they walked an average of nearly half the length of a football field farther during a six-minute walking test. Those with mild movement impairments had the best results.

“These benefits were realised regardless of how long it had been since their stroke,” said study lead author Elizabeth Regan, a Ph.D. candidate in exercise science at the University of South Carolina.

Mixed aerobic exercise provided the greatest improvement, followed by walking, cycling and recumbent stepping – a machine that allows stepping while in a seated position.

The study was published in the Journal of the American Heart Association.

Leading cause of disability

“Our analysis included stroke survivors across a wide range, from less than six months to greater than a year since their stroke, and the benefits were seen whether they started an aerobic exercise programme one month or one year after having a stroke,” Regan explained in a journal news release.

Stroke is the leading cause of disability in the United States. Physical therapy is often prescribed for stroke survivors to improve physical impairments. Most current stroke rehabilitation has little to no focus on aerobic fitness.

“The physical therapy we currently provide to patients after a stroke focuses more on improving the ability to move and move well rather than on increasing how far and long you can move,” Regan said. “It doesn’t matter how well you can walk if your endurance level keeps you at home.”

Study co-author Stacy Fritz, an associate professor of exercise science at the University of South Carolina, said that cardiac rehabilitation programmes may offer benefits to stroke patients “who have health risks and endurance losses similar to traditional cardiac rehab participants.

“Almost every hospital has a cardiac rehab programme, so it’s an existing platform that could be used for stroke survivors. Funnelling patients with stroke into these existing programmes may be an easy, cost-effective solution with long-term benefits,” Fritz said.

Image credit: iStock

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Gene therapy for rare eye disease set to be offered on NHS

Patients with a rare inherited eye disorder are set to be offered a new gene therapy on the NHS.

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Cannabis may hold promise to treat PTSD but evidence lags behind use

As growing numbers of people are using cannabis to treat post-traumatic stress disorder (PTSD), a new UCL study reports that prescriptions are not backed up by adequate evidence.

The systematic review, published in the Journal of Dual Diagnosis, finds that the active components of cannabis, called cannabinoids, may hold promise as a treatment for PTSD, particularly for reducing nightmares and helping people sleep, but more research is needed to determine whether these drugs should be used in routine clinical practice.

“There has been a recent surge of interest in the use of cannabinoids to treat PTSD, particularly from military veterans, many of whom are already self-medicating or obtaining prescriptions in some American states,” said the study’s lead author, Dr Chandni Hindocha (UCL Clinical Psychopharmacology Unit).

“The lack of evidence supporting cannabis as a PTSD treatment is striking given the vast interest in it, and the large unmet need for better PTSD treatments,” she said.

PTSD is a potentially debilitating condition affecting roughly 1% of the UK population, typically consisting of re-experiencing a traumatic event through intrusive memories, flashbacks or nightmares, and often involves hyper-reactivity (a state of constant vigilance) and insomnia.

Psychotherapies (talking therapies) including trauma-focussed cognitive-behavioural therapy have been shown to be effective for PTSD. However, not everyone can access talking therapies and they do not work for everyone, so many people still need to take prescribed medications. Existing drugs approved for PTSD do not work for everyone, and can have side effects, so researchers say there is an urgent need to identify new treatments.

A growing number of people have turned to cannabinoids, which is an approved treatment for PTSD in most states in the USA that permit medical cannabis.

Cannabinoids, the active ingredients of cannabis, which include tetrahydrocannabinol (THC) and cannabidiol (CBD), may be helpful at treating PTSD as they can change how the brain processes memories. The cannabinoids act on the brain’s in-built endocannabinoid system which also regulates other brain functions that are affected by PTSD.

The research team conducted a systematic review of all studies where someone with a PTSD diagnosis has been using a cannabinoid to reduce their symptoms, and they assessed the quality of each study.

They found 10 studies that met their criteria, which cover a range of products including smoked cannabis, THC or CBD separately in oil or pill form, and a synthetic cannabinoid called nabilone.

Every study had medium to high risk of bias and all were assessed as low in quality due to limitations such as small sample size, retrospective study design, lack of a control group or placebo, short follow-up periods, and not reporting other medication use or addiction. Only one study was a randomised controlled trial, investigating nabilone, but it was in a small sample over a relatively short period of time.

The researchers say there are still many unanswered questions about the safety and efficacy of cannabis-based medications for PTSD, and potential long-term effects such as addiction or a risk of psychosis.

The existing evidence shows promise, however, as some studies showed that cannabis products appeared to reduce PTSD symptoms such as insomnia and nightmares.

“Based on the evidence, we cannot yet make any clinical recommendations about using cannabinoids to treat PTSD. Current prescribing of cannabinoids for PTSD is not backed up by high quality evidence, but the findings certainly highlight the need for more research, particularly long-term clinical trials,” said the study’s senior author, Dr Michael Bloomfield (UCL Psychiatry and the Traumatic Stress Clinic, St Pancras Hospital).

“Many of these studies have been conducted in military veterans, but we also need to be looking at other groups, as PTSD can vary depending on the nature of the trauma so different approaches may benefit different groups,” he added.

Dr Hindocha added: “Unfortunately, medicinal uses of cannabis have historically been difficult to study due to legal restrictions, so it could take a long time before there is enough evidence to support clinical recommendations. New approaches are needed to make the most of existing evidence in the meantime.”

The study was conducted by researchers at UCL and the University of Amsterdam, and was supported by the National Institute for Health Research UCLH Biomedical Research Centre.

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