Monday, January 14, 2019

Can Exercise Lower High Blood Pressure as Effectively as Drugs?

According to the Centers for Disease Control and Prevention (CDC), approximately 75 million adults in the United States have to manage high blood pressure, where it exceeds the threshold of 140 millimeters of mercury (mm Hg). The condition can increase their risk of developing heart disease or experiencing a stroke, both of which are leading causes of death in the U.S. Moreover, high blood pressure drives an expense of around $48.6 billion per year nationally, including the cost of medication, accessed health care, and absence from work.

People with high blood pressure typically follow an antihypertensive or blood pressure-lowering treatment, which includes special medication. At the same time, specialists sometimes advise that people make lifestyle changes to help them manage their blood pressure. One such change is to take regular, structured exercise.

However, no studies have yet compared the effectiveness of physical activity in lowering blood pressure with that of antihypertensive medication. A new study in the British Journal of Sports Medicine — a BMJ publication — aims to address this gap in the literature.
In the current study, they looked at the data from 194 clinical trials that focused on antihypertensive drugs and their impact on systolic blood pressure, and another 197 clinical trials, looking at the effect of structured exercise on blood pressure measurements. In total, these trials collected information from 39,742 participants.

They found that antihypertensive drugs were more effective in lowering blood pressure than structured exercise in the case of the general population. However, when they looked specifically at people with high blood pressure, they saw that exercise was as effective as most blood-lowering medication. Moreover, the study authors concluded that there is "compelling evidence that combining endurance and dynamic resistance training was effective in reducing [systolic blood pressure]."

Friday, January 11, 2019

Are Infectious Complications Following Probiotics an Underestimated Problem?

Probiotics seem to be everywhere. From dietary supplements to chocolate bars, these products are designed to improve one’s microbiome. Yet, there have been few serious evaluations of complications related to probiotic ingestion. This study presents a synthesis and critical evaluation of the reports and series of cases on the infectious complications related to the ingestion of probiotics, which can raise awareness for the prescribing and use of probiotics for certain groups of patients. The researchers emphasize that this study is not meant to discourage the use of probiotics, but to instead better understand that certain high-risk patients may not benefit from the introduction of probiotics in a clinical setting.

In this study, published in BMC Complementary and Alternative Medicine, researchers culled and systematically reviewed the data from PubMed, SciELO and Scopus databases published until August 2018. They found 60 case reports and 7 case series, making up a total of 93 patients. Among those studies, they found certain strains of probiotics were responsible for the most complications. They also found common factors associated with mortality, including infants and the elderly with compromised immunity and the prevalence of C. dificile, colitis and antibiotic use.

The authors note “to assume that probiotic intake is completely risk-free is not true. The proportion of cases of infectious complications is small when the total number of people who use probiotics is considered. However, the cases described here are infections with high mortality rates such as endocarditis and sepsis. So, although on one hand there is the possibility of publication bias, with more serious cases having been published, on the other, due to the mentioned limitation for the publication of case reports, several other serious cases may not have reached public knowledge.”

The use of probiotics cannot be considered risk-free and should be carefully evaluated for some patient groups. The most frequent probiotic-related infectious complications were fungemia and sepsis and the most frequent probiotic microorganisms were of the genus Saccharomyces, a fungus. Mortality was associated with age > 60 years, C. dificile colitis, current antimicrobial use and Saccharomyces infection. Probiotics were often used in the context of excessive antibiotic use, and a more judicious use of antibiotics is critical, as the use of probiotics cannot be considered risk free and should be carefully evaluated for high-risk groups of patients.

Wednesday, January 9, 2019

Wisdom Wednesday: Headaches Attributed to Trauma to the Head or Neck


Headache attributed to trauma or injury to the head and/or neck are among the most common secondary headache disorders. During the first 3 months from onset they are considered acute; if they continue beyond that period they are designated persistent. This time period is consistent with ICHD-II diagnostic criteria, although the term persistent has been adopted in place of chronic.

There are no specific headache features known to distinguish the Headache attributed to trauma or injury to the head and/or neck from other headache disorders; most often these resemble Tension-type headache or Migraine. Consequently their diagnosis is largely dependent upon the close temporal relation between the trauma or injury and headache onset. Consistently the diagnostic criteria of ICHD-3 for all types of Headache attributed to trauma or injury to the head and/or neck require that headache must be reported to have developed within 7 days following trauma or injury, or within 7 days after regaining consciousness and/or within 7 days after recovering the ability to sense and report pain. Although this 7-day interval is somewhat arbitrary, and some experts argue that headache may develop after a longer interval in a minority of patients, there is not enough evidence at this time to change this requirement.

Headache may occur as an isolated symptom following trauma or injury or as one of a constellation of symptoms, commonly including dizziness, fatigue, reduced ability to concentrate, psychomotor slowing, mild memory problems, insomnia, anxiety, personality changes and irritability. When several of these symptoms follow head injury, the patient may be considered to have a post-concussion syndrome.

The pathogenesis of Headache attributed to trauma or injury to the head and/or neck is often unclear. Numerous factors that may contribute to its development include, but are not limited to, axonal injury, alterations in cerebral metabolism, neuroinflammation, alterations in cerebral haemodynamics, underlying genetic predisposition, psychopathology and a patient’s expectations of developing headache after head injury. Recent research, using advanced neuroimaging modalities, suggests a potential for detecting brain structural, functional and metabolic abnormalities following minor trauma that are not detectable through conventional diagnostic tests. Post-traumatic sleep disturbances, mood disturbances and psychosocial and other stressors can plausibly influence the development and perpetuation of headache. The overuse of abortive headache medications may contribute to the persistence of headache after head injury through the development of Medication-overuse headache. Clinicians must consider this possibility whenever a post-traumatic headache persists beyond the initial post-trauma phase.

Monday, January 7, 2019

Artificial Sweetners

Objective:
To assess the association between intake of non-sugar sweeteners (NSS) and important health outcomes in generally healthy or overweight/obese adults and children.

Design:
Systematic review following standard Cochrane review methodology.
Data sources Medline (Ovid), Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and reference lists of relevant publications.

Eligibility criteria for selecting studies:
Studies including generally healthy adults or children with or without overweight or obesity were eligible. Included study designs allowed for a direct comparison of no intake or lower intake of NSS with higher NSS intake. NSSs had to be clearly named, the dose had to be within the acceptable daily intake, and the intervention duration had to be at least seven days.

Main outcome measures:
Body weight or body mass index, glycaemic control, oral health, eating behaviour, preference for sweet taste, cancer, cardiovascular disease, kidney disease, mood, behaviour, neurocognition, and adverse effects.

Results:
The search resulted in 13 941 unique records. Of 56 individual studies that provided data for this review, 35 were observational studies. In adults, evidence of very low and low certainty from a limited number of small studies indicated a small beneficial effect of NSSs on body mass index (mean difference −0.6, 95% confidence interval −1.19 to −0.01; two studies, n=174) and fasting blood glucose (−0.16 mmol/L, −0.26 to −0.06; two, n=52). Lower doses of NSSs were associated with lower weight gain (−0.09 kg, −0.13 to −0.05; one, n=17 934) compared with higher doses of NSSs (very low certainty of evidence). For all other outcomes, no differences were detected between the use and non-use of NSSs, or between different doses of NSSs. No evidence of any effect of NSSs was seen on overweight or obese adults or children actively trying to lose weight (very low to moderate certainty). In children, a smaller increase in body mass index z score was observed with NSS intake compared with sugar intake (−0.15, −0.17 to −0.12; two, n=528, moderate certainty of evidence), but no significant differences were observed in body weight (−0.60 kg, −1.33 to 0.14; two, n=467, low certainty of evidence), or between different doses of NSSs (very low to moderate certainty).

Conclusions:
Most health outcomes did not seem to have differences between the NSS exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited. Future studies should assess the effects of NSSs with an appropriate intervention duration. Detailed descriptions of interventions, comparators, and outcomes should be included in all reports.

Friday, January 4, 2019

Does magnesium hold the key to vitamin D benefits?

Vitamin D, also known as the sunshine vitamin, has enjoyed something of a celebrity status, receiving praise for a multitude of health benefits. Yet, in the complex web of biological processes that govern our health, few players ever work in isolation. New evidence shifts the focus onto magnesium, implicating it in playing a central role in determining how much vitamin D our bodies can make.

In a study that features in the December issue of The American Journal of Clinical Nutrition, a research team from Vanderbilt University Medical Center in Nashville, TN concludes that optimal levels of magnesium may play an important role in the vitamin D status of an individual.

Dr. Qi Dai, a professor of medicine at Vanderbilt University Medical Center and the lead study author, previously reported on the relationship between magnesium intake and vitamin D levels in over 12,000 individuals taking part in the National Health and Nutrition Examination Survey (NHANES) 2001–2006 study.

Here, Dr. Dai and team found that individuals with high levels of magnesium intake, whether from dietary sources or taking supplements, were less likely to have low levels of vitamin D. Importantly, the researchers also found a possible association between magnesium intake and a reduction in mortality, particularly when they looked at mortality due to cardiovascular disease and bowel cancer.

So, how does magnesium affect vitamin D biology in the body? It is a cofactor in the synthesis of vitamin D from both exposure to sunlight and dietary sources. "Magnesium deficiency shuts down the vitamin D synthesis and metabolism pathway," Dr. Dai explains.

Monday, December 31, 2018

2018 In Review

Traditionally, I use the last post of the year to review Bill’s Blog. I posted 143 blogs this past year bringing my total to 835 since fall of 2013. I’ve also started doing an occasional podcast with Kristen Bomas. There are currently only two that you can view on You tube – one on breast cancer and the other on medical marijuana.

The most common topic last year was various health conditions. This accounts for 20% of my blogs. I wrote about advances in MS, Parkinson’s disease and frequently about various aspect of metabolic syndrome. Much of the information was on environmental factors associated with these chronic diseases. Low grade viral infections and pervasive pesticides have both been implicated in a third of all autoimmune disease.

Tied for second at 17% were three topics – health care standards, supplementation and diet. The last two subjects have been popular topics of my blog since conception in 2013. Medical standards of care didn’t even make the top 10 last year. There is a dichotomy developing in health care. A large percentage of physicians stick by old standards of care that have been dropped and refuse to adopt the new evidence based research standards. The ongoing recommendation of aspirin for primary prevention of cardiovascular events is a prime example. Ongoing resistance against testing A1c to diagnosis diabetes is another.

In fifth place at 13% were blogs about various drugs. Recent research reveals less than 12% of Americans are considered healthy. By definition, that means free from all aspects of metabolic syndrome without taking any prescription drugs. The average U.S. adult takes four prescription drugs daily, one less than the definition of polypharmacy (taking 5 or more medications daily). To manage polypharmacy, a physician needs specialized training in drug interactions that few physicians have.

Environment was sixth accounting of 8% of last year’s blogs. Mounting pollution, global warming and easing of environmental protections in the United States were frequent topics. Here in South Florida the rising sea level during periods of high tides and the obvious death of our coral reefs are daily reminders for me as a member of the boating community.

Exercise came in seventh with only 2% of my blogs. Part of the reason I conduct this review is to make improvements the following year. In 2014, I increased my blog from one to three times a week. The next year, I added Wisdom Wednesday to focus aspects of daily practice. Two years ago, I shifted my emphasis toward more positive aspects of health as I felt I too often reported on negative aspects of health care. Next year, I promise to write more blogs about exercise.

Bottom Line:
I hope you enjoy reading my blogs as much as I enjoy writing them. My techie, Jarrod tells me that blogs are passé – podcasts are the new thing. We’ll see how that develops. If you would to watch any of my podcasts, Kristen has invited me to be a returning guest on “Thursday at 12:45” every six weeks. Just go to “You Tube” and type in Kristen Bomas to view. Regardless, I will continue to write my blog as it keeps me abreast of the current research.

Friday, December 28, 2018

HDL: The "Good" Cholesterol

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

There are two main types of cholesterol: HDL (good) cholesterol and LDL (bad) cholesterol:
HDL stands for high-density lipoproteins. It is called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body. LDL stands for low-density lipoproteins. It is called the "bad" cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.

A blood test can measure your cholesterol levels, including HDL. When and how often you should get this test depends on your age, risk factors, and family history. With HDL cholesterol, higher numbers are better, because a high HDL level can lower your risk for coronary artery disease and stroke. How high your HDL should be depends on your age and sex:

Group Healthy HDL Level
Age 19 or younger More than 45mg/dl
Men age 20 or older More than 40mg/dl
Women age 20 or older More than 50mg/dl

If your HDL level is too low, lifestyle changes may help. These changes may also help prevent other diseases, and make you feel better overall: Eat a healthy diet, stay at a healthy weight, exercise, avoid cigarettes, and limit alcohol.

Some cholesterol medicines, including certain statins, can raise your HDL level, in addition to lowering your LDL level. Health care providers don't usually prescribe medicines only to raise HDL. But if you have a low HDL and high LDL level, you might need medicine.