Friday, July 13, 2018

Cardiovascular Disease: Risk Assessment with Nontraditional Risk Factors

Cardiovascular disease is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by the Framingham Risk Score, the Pooled Cohort Equations, or similar CVD risk assessment models. If current CVD risk assessment models could be improved by adding more risk factors, treatment might be better targeted, thereby maximizing the benefits and minimizing the harms.

Detection - The USPSTF found adequate evidence that adding the ABI, hsCRP level and CAC score to existing CVD risk assessment models may improve calibration, discrimination and reclassification. The USPSTF chose to review these 3 nontraditional risk factor because prior evidence reviews identified them as the most promising to improve on existing CVD risk assessment tools.

Benefits - The USPSTF found inadequate evidence to assess whether treatment decisions guided by ABI, hsCRP level, or CAC score test results, when added to existing CVD risk assessment models, lead to reduced incidence of CVD events or mortality.

Potential Harms – Testing for hsCRP level and the ABI is noninvasive, and there is little direct harm from the tests. Harms of testing for CAC score include exposure to radiation and incidental findings on computed tomography of the chest, such as pulmonary nodules, that may lead to further invasive testing and procedures. Abnormal test results may lead to further testing, procedures, and lifelong medication use without proof of benefits but with expense and potential adverse effects for the patient. Psychological harms may results from reclassification into a higher-risk category for CVD events.

Wednesday, July 11, 2018

Wisdom Wednesday: Lifelong CMV Infection Improves Immune Defense in Old Mice


Epidemiological studies have shown a correlation between CMV infection and immune system aging, especially in elderly populations. It remains unclear whether CMV infection is a key driver of, or simply a factor associated with, aging of the immune system. In this study, we show that CMV infection improves T cell immunity in old animals by broadening the immune response to a different pathogen. Animals that have aged with CMV are able to recruit novel T cells into these immune responses that are present in, but not utilized in, animals aging without CMV. This data squarely challenges the premise that CMV is solely detrimental to the aging of the adaptive immune system.

My Take:
The abstract was very technical so I didn’t repeat it here. However, these researchers basically exposed old mice with a history of CMV and a control group to Listeria monocytogenes then looked at the immune response. They postulate that we share coevolution with CMV that may include potentially positive impacts on adaptive heterologous immunity in late life.

In younger patient populations, CMV and EBV (Epstein - Barr virus) are documented factors in at least a third of all autoimmune cases. So this study showing an immune stimulation by CMV in older patients is not surprising.

In immune compromised patients, like HIV/AIDS, CMV can cause life threatening disease.

The real question is CMV a positive or negative factor in health? In my opinion, it has the potential for both. If your immune system is balanced, then CMV probably plays a positive role. However, if your immune system is compromised or overstimulated (autoimmune disease) then the effects are negative.

As we age, our immune systems tend to decline, so the immune stimulation from a chronic CMV infection may very well provide a boost to immune function. Again, as long as the immune system is healthy to begin with.

Monday, July 9, 2018

Vitamin N Deficiency

For the first time in history, the majority of the world’s population now live in urban setting rather than rural settings. This trending switch has taken us away from nature, which has taken a collective toll on our health.

With urbanization on the rise, people are less engaged with nature. No longer do we have the need to interact with nature for survival. Instead our relationship with the natural world is primarily based on recreation and enjoyment, and it’s minimal at best. As a result, many people suffer from what American writer, Richard Louv, calls “nature deficit disorder,” defined as a “diminished ability to find meaning in the life that surrounds us.”

In Louv’s book, Last Child in the Woods, he explains that nature affects “everything from a positive effect on the attention span, to stress reduction to cognitive development and a sense of wonder and connection to the earth.” With incidences of heart disease, diabetes and cancer continuing to rise, as well as escalating mental health issues, research is linking artificial stimulation to exhaustion and a loss of health and vitality. Simultaneously, mounting scientific evidence points to the positive effects that interacting with nature has on a person’s physical and mental well-being.

Even though the amount and type of nature accessible to people is varied, our desire to connect with it somehow seems to be universally embedded in our DNA. As humans, our cells expect and thrive on natural sunlight, fresh water and air. Not having such a connection is, no pun intended, “unnatural”. Spending days in windowless rooms with artificial light and glowing screens from televisions, computers and smartphones denies us the necessary symbiotic relationship we need with the natural world to thrive. Our bodies haven’t evolved to keep pace with what is now a disconnect from nature. At our core, we’re still hunters and gatherers. In other words, our bodies need what nature give us, and that may always be the case.

The pendulum seems to be swinging back and we are seeing a shift back to nature. From fast food to more “slow” organic foods, a rise in popularity of dietary lifestyles rooted in hunting and foraging ancestral patterns and a resurgence of planned parks amidst urban sprawl, we are seeking a reconnection with nature. “Grounding” or “earthing”, a practice that involves walking barefoot on the earth’s surface, is also gaining popularity. Research has shown “earthing” can reduce inflammation promote wound healing, strengthen the immune system, and prevent or even help to alleviate chronic diseases, including autoimmune diseases.

Even in hospital settings, people are planting trees and gardens. Studies have shown that connecting to nature can speed recovery from surgery just being around plants or images of nature helped to heal the body faster and more efficiently. Patients with garden access on hospital grounds demonstrated positive health outcomes, such as less stress and anxiety, a positive outlook and faster healing.

Friday, July 6, 2018

Water Quality Reports

I just received the 2017 Annual Drinking Water Quality Report from the City of Deerfield Beach. The city has a longstanding reputation for providing high-quality drinking water. Their monitoring program tests over 90 regulated and unregulated compounds, with some tested regularly, following the standards required by the Environmental Protection Agency (EPA) and the Florida Department of Health in Broward County.

The source of water for the City of Deerfield Beach is ground water pumped from two aquifers: the Biscayne and the Floridian aquifers. The Biscayne aquifer is an underground geologic formation made up of highly permeable limestone and less permeable sandstone located under a portion of South Florida. The Biscayne is the shallower of the two aquifers, extending to depths of approximately 240 feet along the coast of South Florida and is the major source of ground water for Miami-Dade, Broward and Palm Beach counties. The Florida aquifer is deeper than the Biscayne and extends to depths of about 3,000 feet and has much higher mineral content, thus making the treatment process considerably more expensive. The raw water pumped from these aquifers is treated by three distinct processes: Lime Softening, Nanofiltration, and Reverse Osmosis.

Lime softening reduces the hardness of water from the Biscayne aquifer with quicklime. Then the water passes through high rate granular media filters to reduce turbidity. Disinfection is then achieved by choramination, combining chlorine and ammonia. Low levels of fluoride are also added to help with the prevention of tooth decay.

Nanofiltration of water, also from the Biscayne aquifer runs in a parallel path to lime softening and is then mixed with the softened water prior to disinfection.

Reverse osmosis is reserved for the deeper Florida aquifer water. The source water is treated under high pressures and sent through semipermeable membranes to remove salt and other inorganic minerals to produce drinking water. Again, the waters are blended with those produced from Lime Softening and Nanofiltration prior to disinfection.

The water quality test results include microbiological contaminants like E. coli from human and animal fecal waste. Radium, from erosion of natural deposits is the most common radioactive contaminant measured. Several inorganic contaminates are also monitored. A few examples are: Antimony from petroleum refineries, fire retardants, ceramics, electronics and solder. Arsenic runoff from orchards. Barium from drilling waste water. Fluoride discharged from fertilizer and aluminum factories and as a water additive. Copper and lead come from the corrosion of household plumbing systems and leaching from wood preservatives.

Monday, July 2, 2018

Detoxification


Toxicity is a ubiquitous health issue. I frequently have new patients fill out a symptom survey. It groups symptoms by organ systems. Over 95% of patients will show liver toxicity as their number one source of symptoms. The other 5% generally show a tie between liver and some other organ.

Many nutritionists start their patients with a detox program. However, I don’t believe detox is the place to start. In the QA (Quintessential Applications) protocol, liver detoxification is step 19 of 32. Inflammation is where treatment must begin, followed by immune system, general metabolism and endocrine function. Then, and only then can liver detoxification truly be effective. Digestion is a wild card and may have to be addressed before or after any of these other systems.

Toxins can contribute to fatigue, difficulty sleeping, indigestion, food cravings and weight gain, reduced metal clarity, low libido, skin issues and joint discomfort.

There are currently 80,000 synthetic chemicals registered for use in the United States. Over 800 million pounds of herbicides are used each year on our crops. Current research shows 167 industrial chemicals are found in adults with no employment-related exposure.

There are three phases of detoxification, the first two occur in the liver:

Phase 1 – The body transforms fat-soluble toxins to an “unlocked” state that is more water-soluble, and in many cases, more toxic than its original form. For almost all natural substances however, phase 1 is all that is need prior to transport to the bowel or kidneys. Caffeine, for example, only has to go through phase 1 detox.

Phase 2 – The highly toxic substances produced in Phase 1 convert to non-toxic molecules and become even more water-soluble. Up until about 100 years ago, phase 2 liver detox was reserved for hormone and alcohol detoxification. And those hormones were produced by you (endogenous) as no exogenous hormones existed. Estrogen, becomes dehydroxyestrogen in phase 1, some forms of which are carcinogenic. In phase 2 estrogen becomes a harmless, water-soluble compound excreted in the bowel and urine.

Phase 3 – Elimination of water-soluble toxins via the bowel and kidneys.

Most detox programs ramp up phase 1 detox. When phase 2 detox lags behind the result is an increase in highly toxic substances produced in phase 1 and the patient experiences “detox symptoms.”

The key is to support phase 2 detox first, then phase 3 and finally phase 1. We accomplish that by addressing steps 1-18 in the QA protocol prior to attempting liver detoxification.

The Bottom Line:
Detoxification is a significant issue for anyone living in the twenty-first century. However, you must improve general health and specific systems prior to a successful detox program.

Friday, June 29, 2018

16:8 Fasting Diet Actually Works

A form of intermittent fasting known as the 16:8 diet helps obese individuals to lose weight and lower their blood pressure, according to a new study.

More and more people now turn to intermittent fasting as a fast and effective way to lose weight. There are different forms of this diet, depending on the time intervals of “fasting” and “feasting.” The so-called 5:2 diet, for instance, consists of eating normally for 5 days every week and fasting for 2 days. In the fasting days, the dieter restricts their calorie intake to 500 or 600 per day. In the daily fasting, or the 16:8 diet, people eat whatever they like for 8 hours and fast for the remaining 16.

A new study evaluates the benefits of this 16:8 pattern for obese individuals and finds that not only does the diet work, but also that it helps to lower blood pressure.

As many as 93.3 million adults have obesity in the United States, according to the latest data from the Centers for Disease Control and Prevention (CDC). That’s almost 40% of the country’s entire population.

This research was led by corresponding author Krista Varady, an associate professor of kinesiology and nutrition at the University of Illinois at Chicago, and the findings were published in the journal Nutrition and Healthy Aging.

Varady and colleagues recruited 23 obese study participants who were aged 45 years, on average, with the average body mass index (BMI) of 35. Between 10 a.m. and 6 p.m., the participants could eat whatever and however much they liked, but they were only allowed to drink water and calorie-free drinks for the remaining 16 hours.

Wednesday, June 27, 2018

Wisdom Wednesday: Fish Oil Consumption Does Not Increase Bleeding Risk


Fish oil is rich in omega-3 fatty acids EPA and DHA. Increased intake of EPA and DHA is beneficial for cardiovascular health, cognitive function, mental health, maternal and child health, immunity and inflammation. EPA and DHA supplements are becoming more and more popular across a wide diversity of people, from healthy individuals to vulnerable population with impaired health.

Higher omega-3 concentrations may compete with fatty acids such as arachidonic acid for metabolizing enzymes. The interaction results in a decreased production of compounds that induce platelet aggregation and an increased production of compounds with anti-platelet properties, hence the anticoagulation benefits of omega-3. However, for patients who are under antithrombotic therapy (either with platelet aggregation inhibitors such as aspirin or anticoagulant drugs such as warfarin), the potential risk of bleeding due to the concurrent use of omega-3 fatty acids has been a concern by many clinicians, particularly surgeons.

Multiple clinical studies have been conducted to investigate whether omega-3 fatty acids pose a clinically significant bleeding risk. So far, the findings have been consistent:

A 2004 Cochrane review of 48 randomized controlled trials and 41 epidemiological analyses concludes that 0.4-7 g/day omega-3 fatty acids do not result in any change in clinical bleeding manifestations.

A 2007 review of 19 clinical studies involving nearly 4400 surgical patients concludes that the risk for clinically significant bleeding was virtually nonexistent with the use of 1.4-21 g/day of omega-3 fatty acid supplements, even with the concurrent use of antiplatelet or antithrombotic medications.

A 2013 systematic review of 10 randomized trails involving nearly 1000 adults 60 years or older concludes that there is no difference in total adverse event rates between daily use of placebo or 0.03-1.86 g EPA and/or DHA for 6-52 weeks.

A 2014 review of 7 randomized controlled trails and 3 epidemiological studies concludes that omega-3 fatty acid treatment has no effect on the risk of clinically significant bleeding and there is no support for discontinuing the use of omega-3 fatty acids before invasive procedures.

A 2017 systematic review based on 32 publications on healthy subjects and 20 publications on patients undergoing surgery finds that fish oil supplements reduce platelet aggregation in healthy subjects and do not increase intra- or post-operative bleedings in patients, and concludes that discontinuation of fish oil supplements prior to surgery is not recommended.