Monday, November 19, 2018

Breast cancer: Omega-3-rich diet may stop tumors from spreading

New research shows that a diet rich in marine omega-3 fatty acids shows the growth and spread of breast cancer cells in female mice. The diet enriched with omega-3 also improved the rodents’ survival.

A vast body of research hails the benefits of a diet rich in omega-3 fatty acids. These healthful fats are found in fish, seafood, nuts, and seeds, as well as in fish oil, plant oils and some fortified foods.

For example, an extensive study of almost half a million people, which lasted around 16 years, recently found that eating more fish and long-chain omega-3s reduces the risk of mortality and may prolong life. Omega-3s may improve cardiovascular and cognitive function, potentially stave off depression, and have a positive impact on a person’s mental health, some studies maintain.

Emerging research has explored the link between omega-3s and cancer. Observational studies have linked diets rich in marine omega-3 fatty acids with a lower risk of breast cancer. Some molecular studies have suggested that omega-3s may stop cancer by activating the body’s natural pain-killers.

Now, experiments in mice add to the mounting evidence that dietary omega-3s may have cancer-fighting properties. In a new paper published in the Journal of Mammary Gland Biology and Neoplasia, researchers fed two groups of adult female rodents nearly identical diets. However, one group ate a diet rich in olive oil-derived omega-6 polyunsaturated fats, whereas the other group received food containing omega-3-rich fish oil.

Then, the researchers injected the mice with 4T1 breast cancer cells, which cause tumors to spread quickly to the breast glands. Furthermore, 4T1 cells can spontaneously migrate to other sites, such as bone, the lungs, and liver.

Friday, November 16, 2018

Probiotics: When Good Bacteria Turn Bad

As the popularity of probiotics grows, scientists are turning more of their attention to these tiny particles. With the spotlight intensifying, some researchers suspect that their impact may not be beneficial for everyone.

The concept of people improving their intestinal health by eating live organisms is not a new one but dates back almost 100 years. Today, however, the idea is mainstream. Grocery stores across the United States sell a range of products that contain probiotics and offer the promise of improved gut health.

Despite their growing popularity and impressive claims, research into the potential health benefits of probiotics is still relatively sparse and not entirely positive.

University of Texas engineers attached human cells to microchips and, depending on the cell type they chose, watched them mimic any organ in the body. The scientists were interested in understanding why inflammation arose in the digestive system. They recently published their work in the Proceedings of the National Academy of Sciences, in a study that marks the first time that an organ-on-a-chip has modeled the development of a disease.

To date, scientists have found it challenging to understand exactly why and how gut inflammation develops. The process involves communication between the epithelial cells that line the gut, the immune system, and the microbiome. These physiological components engage in a chemical dialogue that involves a dizzying array of secretions – and deciphering the interactions is difficult.

The researchers concluded that the main driver of gut inflammation is the health of the intestinal epithelium – specifically, its permeability. The intestinal epithelium is a thin layer of cells that have a protective role – namely, to prevent toxins and bacteria from the gut leaching out into the rest of the body, where they could cause harm.

As part of their study, the scientists considered the impact of probiotics. They found that so-called good bacteria might be healthful for some people but have a negative health impact for others. It seems that their influence depends on the integrity of the intestinal epithelium.

Wednesday, November 14, 2018

Wisdom Wednesday: Ignoring Patient Input Tied to Diagnostic Error

Patients’ views are not often included in records of diagnostic errors, but new data released today suggest that patient and family narratives may contain key information that should formally be included in the system.

To learn more about how patient experience and patient-physician interactions might affect the risk for diagnostic error, Traber Davis Giardina, PhD, MSW, and colleagues analyzed reports submitted from January 2010 to February 2016 to the nonprofit Empowered Patient Coalition.

The coalition began collecting family experiences to learn more about safety events from the patient’s point of view. Patients, family members, and caregivers voluntarily submit data by responding to questions and adding their own text.

The researchers identified 184 unique patient stories of diagnostic error. Amid those narratives, problems in patient-physician interactions emerged as the major factor in the errors. “Our analysis identified 224 instances of behavioral and interpersonal factors that reflected unprofessional clinician behavior, including ignoring patients’ knowledge, disrespecting patients, failing to communicate, and manipulation or deception,” they write.

About two thirds (67.9%) of the narratives were contributed by female patients, and most of the reported diagnostic errors (79.9%) took place in a hospital. Although more than half of participants said that they had reported the incident either to the institution where it happened or to a governing body, only 9% said they were satisfied by the response, the authors write.

One woman wrote, “I was her first-born child, had worked in a major teaching hospital for years and thought I could manage her care, and make certain she was well taken care of…. I found I was unable to do so, since I was continually ignored…. I failed her.”

Friday, November 9, 2018

‘Eye Health’ Supplements

To help clinicians guide patients, this article provides a practical overview on three of the most common ocular conditions for which supplements and dietary factors may play a role.

Macular Degeneration – The Age-Related Eye Disease Study (AREDS) and the Age-Related Eye Disease Study 2 (AREDS2) are two of the largest and most rigorous clinical trials that have investigated the effects of nutritional supplementation on the progression dry age-related macular degeneration (AMD) to wet AMD. Observational trial also have assessed the impact of diet and supplements on the development and progression of AMD.

Results - Patients without AMD did not benefit from taking the AREDS formulation. Patients with mild or borderline AMD did not benefit from taking either the AREDS or AREDS2 formulation. Both formulations slightly lowered the risk for AMD progression in those patients with intermediate or advanced AMD. Patient who smoke should take the AREDS2 formulation to avoid the beta-carotene in the AREDS formulation, which can increase the risk for lung cancer. Lutein, zeaxanthin, and omega-3 fatty acids were included in the AREDS2 formulation but did not decrease the risk for AMD progression. The Blue Mountains Eye Study found that the consumption of vegetables and dietary lutein and zeaxanthin was associated with a reduced risk for AMD. Patients with intermediate or advanced AMD should be encouraged to take the AREDS or AREDS2 formulation as a nutritional supplement. Smoking is a risk factor for the development and progression of AMD and should be discouraged. Physical activity should be encouraged, as it has been demonstrated to have a modest protective effect. A diet consisting of fish, fruits, leafy greens, and nuts has been shown to be beneficial in some studies.

Wednesday, November 7, 2018

Wisdom Wednesday: Levothyroxine

Up to 7% of the general population has hypothyroidism, which is corrected with thyroid hormone treatment. The general goals of thyroid hormone replacement are to provide resolution of patient symptoms and hypothyroid signs, including biological and physiologic markers of hypothyroidism; achieve normalization of serum thyroid-stimulating hormone (TSH) concentrations with improvement in circulating thyroid hormone concentrations; and avoid overtreatment (eg, iatrogenic thyrotoxicosis), especially in elderly persons.

Levothyroxine, a synthetically made thyroxine (T4), is the predominant form of thyroid hormone replacement used on patients with hypothyroidism. In healthy and iodine-sufficient individuals, the majority of thyroid hormone produced is T4, synthesized exclusively by the thyroid gland, with a smaller amount of T3, which is produced by the thyroid and in peripheral tissues via diodination of the circulating T4.

In the setting of fluctuating T4 levels, deiodinase activity is tightly regulated to maintain normal T3 levels at the various target tissues. In hypothyroidism, the 5’ deiodinase is activated to allow greater conversion of T4 to the bioactive form of thyroid hormone, T3.
Given the high prevalence of hypothyroidism in the general population, levothyroxine has consistently been the most frequently prescribed medication in the United States over the past several years. In 2016, approximately 123 million prescriptions for levothyroxine were dispensed.

Monday, November 5, 2018

Common Blood Pressure Drugs Tied to Increased Lung Cancer Risk

Angiotensin-converting-enzyme (ACE) inhibitors are associated with increased lung cancer risk compared with angiotensin-receptor blockers (ARBs), an observational study in The BMJ suggests.

Using a U.K. primary care database, researchers identified over 900,000 adults who began treatment with a new antihypertensive drug class from 1995 through 2015. Those with histories of cancer were excluded.

During a mean 6 years' follow-up, lung cancer was diagnosed in 0.8% of the cohort. After adjustment for smoking and other confounders, ACE inhibitor use was associated with significantly increased lung cancer risk relative to ARB use (1.6 vs. 1.2 per 1000 person-years). The increased risk didn't appear until after 5 years of ACE inhibitor use, and then increased with increasing duration of use.

The authors note that ACE inhibitors lead to accumulation of bradykinin in the lungs, which "may directly stimulate growth of lung cancer." An editorialist, meanwhile, concludes, "In an individual patient, concerns about the long term risk of lung cancer should be balanced against gains in life expectancy associated with use of [ACE inhibitors]."

My Take:
ACE inhibitors are one of the three antihypertensive medications I mentioned in last Friday’s blog. Remember that I also mentioned that these drugs cause fluid retention in the lungs and legs (congestive heart failure). Bradykinin is a peptide produced in the kidneys that causes vasodilatation thus lowering blood pressure. When the body is in homeostasis, bradykinin is short lived. However, ACE inhibitors cause this peptide to build up in the lungs, along with the edema, where it acts as a carcinogen.

Friday, November 2, 2018

Study Questions Whether Treating Mild Hypertension Benefits Patients

For low-risk patients with mild hypertension, starting antihypertensive drug treatment might not reduce mortality, according to a JAMA Internal Medicine study. The American College of Cardiology and American Heart Association currently recommend that all patients with systolic blood pressure at or above 140 mm Hg or diastolic BP at or above 90 mm Hg receive antihypertensive therapy.

Using U.K. electronic medical records, researchers matched 19,000 adults with mild hypertension (140/90-159/99 mm Hg) and low cardiovascular risk who received antihypertensive medication to another 19,000 who weren't treated. During a median 6 years' follow-up, rates of mortality and cardiovascular disease were similar between the groups. Antihypertensive treatment was, however, associated with higher risk for hypotension, syncope, electrolyte abnormalities, and acute kidney injury.

My Take:
The controversy over treating borderline hypertension escalated when the two organizations noted above reduced the systolic and diastolic levels at which medication should be prescribed. They recommended a full cardiac workup for these patients as well.

Mild hypertension responses well to simple lifestyle changes – exercise, weight loss, and healthier eating habits. Supplementation of vitamin B2 and B3, magnesium or Co Q10 can also be effective. Sometimes something as simple as increasing the quality or quantity of sleep will lower BP to normal levels.

Hypertension medication is a slippery slope. It is, in fact, how most people begin taking prescription medication. Once it starts, it rarely stops and additional medications soon follow.