Monday, December 10, 2018

A Sunny Workout is Best

Want to get fit? Check your vitamin D levels. Cardiorespiratory fitness (CRF) may well be linked to serum vitamin D levels. A study, published in the European Journal of Preventive Cardiology (October 2018), looked at data from nearly 2,000 participants in the National Health and Nutrition Survey. Subjects were between the ages of 20 and 49.

Researchers used VO2 max as an indicator of cardiorespiratory fitness. Used to establish the aerobic endurance of an athlete, VO2 max is the amount of oxygen a person can utilize during intense exercise. By putting a face mask on the subject, the volume and gas concentrations of inspired and expired air can be directly measured.

Of the 1995 participants, 45.2% were women, 49.1% were white, 13% were hypertensive and 4% had diabetes. Vitamin D levels did not vary between matched subjects with confounding variables like diabetes, high blood pressure, age, sex, race, CRP levels, BMI, etc. The one variable that did make a difference between matched subjects was serum vitamin D levels. The researchers found that serum vitamin D levels had a significant effect on cardiorespiratory fitness (VO2 max). Those in the highest quadrille had a VO2 max 2.9 higher on average than those in the lowest quadrille.

According to the authors, “We found a strong independent association between vitamin D levels and CRF, which was robust to potential confounding variables. Future studies are needed to explore the underlying biological mechanisms of the observed association. Clinical trials of vitamin D supplementation are required to validate the relationship.” 

Vitamin D levels have been associated with other cardiovascular issues. Low levels are linked to a higher risk of hypertension, poor outcomes for congestive heart failure patients and overall cardiac mortality. Now we can add cardiorespiratory fitness to that list. Because CRP status may be an indicator of cardiovascular risk, the American Heart Association has recommended that CRP be measured in routine clinical practice.

Friday, December 7, 2018

Higher Risk Thresholds May Be Needed for Starting Statins for Primary CVD Prevention, Study Suggests

The guideline-recommended risk thresholds for initiating statins for primary prevention of cardiovascular disease may be too low, a modeling study in the Annals of Internal Medicine suggests.

Researchers performed a network meta-analysis of studies comparing four low- or moderate-dose statins with no statins in patients aged 40 to 75 with no CVD history. They balanced statins' potential benefit of CVD event prevention with potential harms, like myopathy, hepatic or renal dysfunction, cataracts, hemorrhagic stroke, type 2 diabetes, and cancer.

Most current guidelines recommend statin initiation when a person's 10-year CVD risk is 7.5%–10%. In this study, the benefits only began to outweigh the risks when CVD risk was 14% for men aged 40 to 49. For men 70 to 75 years, the threshold was 21%. For women, thresholds ranged from 17% to 22%.

The authors conclude: "Our results suggest that guidelines should use higher 10-year risk thresholds when recommending statins for primary prevention of CVD and should consider different recommendations based on sex, age group, and statin type."

Of note, guidelines released last month by the American College of Cardiology and American Heart Association consider a 10-year risk score of 7.5%–19.9% to denote "intermediate risk."

Wednesday, December 5, 2018

Wisdom Wednesday: U.S. Life Expectancy Down, Overdose and Suicide Rates Up


U.S. life expectancy at birth has declined for the second year in a row, from 78.7 years in 2015 to 78.6 years in 2016, according to the latest CDC data.

Notable increases were observed in drug overdose deaths and suicides. The overdose rate nearly doubled from 2006 to 2016, hitting 19.8 deaths per 100,000. Meanwhile, suicide rates rose steadily among adults aged 25–44 years, reaching 16.9 deaths per 100,000 — higher than the heart disease death rate. Among those aged 15–24 years, suicide became the second leading cause of death in 2016, and among children aged 1–14 years, the rate reached 0.8 per 100,000.

CDC Director Dr. Robert Redfield said in a statement, "These sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable. ... we must all work together to reverse this trend and help ensure that all Americans live longer and healthier lives."

My Take:
In 2016, the top 10 leading causes of death were heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease, and suicide. Metabolic syndrome, a preventable condition is a direct cause in half of the top causes of death.

Monday, December 3, 2018

Strength Training Bests Aerobics for Cardioprotection

Static exercise, such as strength training, might be superior to dynamic exercise, such as walking or cycling, for conferring protection against cardiovascular disease (CVD), new research suggests.

Using data for the 2005/06 National Health and Nutrition Examination Survey (NHANES), Maia P. Smith, PhD, assistant professor, Department of Public Health and Preventive Medicine, St. George’s University, West Indies, found that 36% of adults 21 to 44 years of age and 25% of adults older than 45 years engaged in static activity, compared with 28% and 21%, respectively, of adults engaging in dynamic activity.

Although both activities were associated with 30% to 70% lower rates of CVD risk factors, the associations were strongest in the static activity group. “In over 4000 American adults from a representative sample, I found that static activity – strength training – appeared more cardioprotective than dynamic activity – in this case walking and biking,” Smith told Medscape Cardiology.

“The odds of having a given risk factor – hypertension, overweight/obesity, diabetes, or high cholesterol – were between one-third and two-thirds lower for those who engaged in static activity that for those who engaged in no activity, but although dynamic activity wasn’t as good as static, it still had some benefits, especially for [those who were] overweight,” she said.

Commenting on the study, Richard C. Becker, MD, professor of medicine, University of Cincinnati College of Medicine, noted that the Physical Activity Guidelines for Americans, highlight moderate-intensity aerobic activity of at least 150 minutes per week and muscle-strengthening activity 2 days per week.

Friday, November 30, 2018

What are the Benefits of Flaxseed Oil?

Humans have used flaxseed oil for thousands of years, and it has a variety of health benefits. Flaxseed oil comes from ripened flaxseeds that manufacturers have cold pressed to extract the oil. Another nane for flaxseed oil is linseed oil. It is commercially available in both capsule and liquid form. It contains a type of omega-3 fatty acid called alpha-linolenic acid (ALA).

Flaxseed oil may help fight certain types of cancer. Although much more research is needed to draw a definite conclusion. Flaxseed oil may also have benefits for the skin and hair, such as reducing some of the symptoms of atopic dermatitis. It may also help lower the risk of diabetes. In one meta-analysis, flaxseed and its derivatives decreased circulating C-reactive protein, which is a marker of inflammation. However, these results were only present in adults who were obese.

Minor adverse effects are possible depending on the dose and the person’s individual reaction. Possible adverse effects include gas, bloating and diarrhea. There is little information on whether or not flaxseed oil is safe to consume while pregnant or breastfeeding.

Flaxseed oil is sensitive to light and heat, so it is best to buy it in an opaque or dark glass bottle to protect it from the light and store it in a cool, dark place. The taste is mild, people can drink a spoonful straight or incorporate it into dips and sauces. People can also use flaxseed oil instead of other oils or butter for cooking. Flaxseed oil is sensitive to heat, so cooking with it will change the nutritional properties. For those who do not want to add flaxseed oil to food, it is also available in capsule form as a supplement.

Wednesday, November 28, 2018

Wisdom Wednesday: How Coffee Protects the Brain


Scientists have now proved that drinking certain types of coffee can be beneficial to brain health, but how does this popular brew support cognitive function? A new study identifies some the mechanisms that allow coffee to keep mental decline at bay.

According to data from the Harvard T.H. Chan School of Public Health in Boston, MA, about 54% of all adults in the United States drink coffee on a daily basis. While drinking coffee can bring both benefit and risks for a person’s health, a 2016 study from the University of Ulster in Coleraine, United Kingdom, concluded that the health benefits of moderate coffee consumption “clearly outweigh” the potential risks.

“Coffee consumption does seem to have some correlation to a decreased risk of developing Alzheimer’s disease and Parkinson’s disease,” notes Dr. Donald Weaver, co-director of the Krembil Brain Institute which conducted the new study.

Dr. Weaver and team’s findings – published in the journal Frontiers in Neuroscience – suggest that the key to coffee’s brain-protecting benefits lie not in its caffeine content, but in the existence of compounds released in the process of roasting the coffee beans.
It is the phenylindanes, rather than any other coffee-related compounds, that seem to inhibit the amalgamation of tau and beta-amyloid. These are toxic proteins, of which the excessive buildup in the brain is a key factor in the neurodegenerative conditions such as Alzheimer’s and Parkinson’s disease.

It appears that a longer roasting time causes the coffee beans to produce more phenylindanes. This suggests that dark roasted coffee – whether regular or decaf – has the strongest protective effect on the brain.

Monday, November 26, 2018

Why a Low-Gluten Diet May Benefit Everyone

New research, published in the journal Nature Communications, finds that a diet low in gluten may also benefit the health of people who are not allergic to it. However, the benefits are not down to the mere absence of gluten.

In autoimmune conditions, such as celiac disease, the body’s immune system reacts to gluten by targeting the small intestine. Those with gluten intolerance, or gluten sensitivity, report that the protein triggers gastrointestinal symptoms, even in the absence of celiac disease.

However, an increasing number of people are adopting a gluten-free diet, even if they do not have celiac disease or gluten allergy. But some recent studies have suggested that doing so may have adverse health consequences, such as raising the risk of developing type 2 diabetes.

Researchers, led by Professor Oluf Pedersen, at the University of Copenhagen in Denmark, set out to investigate whether a diet low in gluten is beneficial for people who are not allergic to it. A randomized trial of 60 healthy Danish adults aged between 22 and 65 years old who did not have celiac disease, diabetes, or any other disorders adhered to an 8-week-long low-gluten diet and high-gluten diet respectively, with a 6-week washout period in between.

The low-gluten diet consisted of 2 grams of gluten per day, while the high gluten diet was comprised of 18 grams of gluten daily. The washout period involved a regular diet with 12 grams of gluten daily. The two diets were similar regarding the number of calories and the quality of the nutrients they contained. However, the composition of fiber differed as the low-gluten diet also contained less fiber from wheat, rye, and barely, as these are primary sources of gluten.

Wednesday, November 21, 2018

Wisdom Wednesday: Drug resistance: Does antibiotic use in animals affect human health?


Antibiotic resistance poses a serious threat to public health, both in the United States and globally. According the Centers for Disease Control and Prevention (CDC), antibiotic resistance is responsible for 25,000 annual deaths in the European Union and 23,000 annual deaths in the U.S. As many as 2 million U.S. individuals develop a drug-resistant infection each year.

By the year 2050, some researchers predict that antibiotic resistance will cause 10 million deaths every year, surpassing cancer as the leading cause of mortality worldwide.

On a global scale, the U.S. and China are the largest users of antibiotics for food production. According to the Food and Drug Administration (FDA), 80% of the total antibiotic use in the U.S. is in agriculture, with pigs and poultry receiving five to 10 times more antibiotics then cattle and sheep.

Farming animals for meat is a particularly intense process, with pig sows, for instance, not being given enough time to recover in-between births. This compromises their immune system. Also, pigs and chickens live in confined, crowded spaces, which increases their stress and the risk of disease transmission.

Additionally, antibiotics are sometimes used to make the animals grow faster. In humans, studies have shown that antibiotics raise the risk of weight gain and obesity, as they wipe out beneficial gut bacteria that help regulate weight.

Finally, the prophylactic, or preventive, use of antibiotics also adds to the problem. Many farms give chicks antibiotics as soon as they are born, regardless of whether they are ill or not.

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.

Wednesday, October 31, 2018

Wisdom Wednesday: ‘Good’ Cholesterol Might Be Bad Too


HDL cholesterol may be known as the “good” kind, but a new study suggests high levels of it are not always a good thing for women after menopause.

The study, of nearly 1,400 postmenopausal women, found that those with higher HDL levels were more likely to show “plaques” in their carotid arteries. Those arteries supply blood to the brain, and plaque buildup there signals an increased risk of both stroke and heart disease.

“We used to think, the higher the better,” said Dr. Karol Watson, director of the Women’s Heart Health Program at the University of California at Los Angeles. “But we’ve been rethinking HDL in recent years.” Watson, who was not connected to the study said “everyone agrees” that low HDL – below 40 mg/dL – is bad. But studies have also found that very high HDL is liked to trouble, too. For example, a 2016 study of over 630,000 people found that women and men with very high HDL – above 90 mg/dL – were more likely to die (of noncardiovascular causes) during the study period than those whose HDL was in the middle of the pack.

HDL is known as the “good” cholesterol because it does positive things, including clearing fat from the arteries and ushering it to the liver to be removed. But, Watson said, research suggests that HDL function can go awry when its environment is not ideal – such as when a person is obese or has diabetes or other health conditions causing chronic inflammation in the blood vessels. “HDL seems to be like a chameleon, changing based on its surroundings,” Watson explained.

Monday, October 29, 2018

Higher Intake of Organic Foods Tied to Lower Cancer Risk

Higher intake of organic foods is associated with lower risk for breast cancer and lymphomas, a JAMA Internal Medicine study suggests.

Nearly 70,000 French adults reported how often they consumed 16 types of organic products (e.g., fruits, vegetables, dairy items) and then were followed for roughly 5 years. During that time, over 1300 new cancers were diagnosed. After adjustment for overall diet and other confounders, cancer risk decreased as organic food consumption increased. In particular, adults with the highest intake of organic foods had a 24% lower risk for cancer than those with the lowest organic intake.

When examined by cancer type, the risk reduction was limited to postmenopausal breast cancer and lymphomas.

Commentators point to numerous study limitations and urge caution in interpreting the findings. They write, "For overall health, current evidence indicates that the benefits of consuming conventionally grown produce are likely to outweigh the possible risks from pesticide exposure. Concerns over pesticide risks should not discourage intake of conventional fruits and vegetables, especially because organic produce is often expensive and inaccessible to many populations."

My Take:
I couldn’t disagree more with the commentator’s conclusions. However, going 100% organic is not feasible for most of us.

Friday, October 26, 2018

Herpes May Account for 50 Percent of Alzheimer's Cases

The herpes virus could account for at least half of Alzheimer's cases, according to a new review of the findings of three recent studies examining links between Alzheimer's and herpes.

The new paper, published in the Frontiers in Ageing Neuroscience journal, also suggests that antiviral drugs may reduce the risk of senile dementia — which is mostly caused by Alzheimer's disease — among people who have severe cases of herpes. Herpes simplex virus 1 (HSV1) is the type of herpes that results in cold sores. HSV1 is a common virus, and the majority of people will have contracted it by the time they reach old age. However, the virus remains permanently in the body and cannot be decisively removed either by the body's natural defense mechanisms or by drugs.

The virus is inactive most of the time, but when a person has HSV1, they may find that flare-ups occur when they are stressed or sick, resulting in characteristic blisters. Medical News Today have reported on several studies this year alone that have provided evidence of a connection between Alzheimer's and herpes. In June, we looked at a study in which postmortem tests on brain tissue support a mechanistic link between Alzheimer's and the herpes viruses HHV-6A and HHV-7. And in July, we brought you news on a study that found the use of antiherpetic medication may dramatically reduce dementia risk.

Study author Professor Ruth Itzhaki, from the University of Manchester in the United Kingdom, found in previous studies that cold sores caused by HSV1 are more prevalent among people that carry a gene variant called APOE-e4, which may increase a person's risk of developing
Alzheimer's. "HSV1 could account for 50 percent or more of Alzheimer's disease cases," she states. Our theory is that in APOE-e4 carriers, reactivation is more frequent or more harmful in HSV1-infected brain cells, which as a result accumulate damage that culminates in development of Alzheimer's."

For this review, she looked at three recent studies on the relationship between Alzheimer's and herpes or chickenpox that analyzed population data from Taiwan, a country which enrolls almost all citizens in the National Health Insurance Research Database.

Wednesday, October 24, 2018

Wisdom Wednesday: Hormone-mimics In Plastic Water Bottles Act As Functional Estrogens


Plastic packaging is not without its downsides, and if you thought mineral water was ‘clean’, it may be time to think again. According to Martin Wagner and Jörg Oehlmann from the Department of Aquatic Ecotoxicology at the Goethe University in Frankfurt am Main, Germany, plastic mineral water bottles contaminate drinking water with estrogenic chemicals.

In an analysis of commercially available mineral waters, the researchers found evidence of estrogenic compounds leaching out of the plastic packaging into the water. What’s more, these chemicals are potent in vivo and result in an increased development of embryos in the New Zealand mud snail. These findings, which show for the first time that substances leaching out of plastic food packaging materials act as functional estrogens, are published in Springer’s journal Environmental Science and Pollution Research.

Wagner and Oehlmann looked at whether the migration of substances from packaging material into foodstuffs contributes to human exposure to man-made hormones. They analyzed 20 brands of mineral water available in Germany – nine bottled in glass, nine bottled in plastic and two bottled in composite packaging (paperboard boxes coated with an inner plastic film). The researchers took water samples from the bottles and tested them for the presence of estrogenic chemicals in vitro. They then carried out a reproduction test with the New Zealand mud snail to determine the source and potency of the xenoestrogens.

They detected estrogen contamination in 60% of the samples (12 of the 20 brands) analyzed. Mineral waters in glass bottles were less estrogenic than waters in plastic bottles. Specifically, 33% of all mineral waters bottled in glass compared with 78% of waters in plastic bottles and both waters bottled in composite packaging showed significant hormonal activity.

By breeding the New Zealand mud snail in both plastic and glass water bottles, the researchers found more than double the number of embryos in plastic bottles compared with glass bottles. Taken together, these results demonstrate widespread contamination of mineral water with potent man-made estrogens that partly originate from compounds leaching out of the plastic packaging material.

Monday, October 22, 2018

What are the Symptoms of High Estrogen?

In males and females, estrogen is an important hormone. High levels of estrogen can cause a variety of symptoms and may increase the risk of developing certain medical conditions.

Females tend to have higher levels of estrogen, while males have more testosterone. In females, estrogen plays a role in the menstrual cycle and reproductive system. In males, it is important for sexual function.

High levels of estrogen in females can lead to weight gain, particularly around the hips and waist. Excess estrogen can also cause menstrual problems, such as irregular periods, light spotting, heavy bleeding, and PMS (premenstrual syndrome). They may also experience bloating, cold hands and feet, difficulty sleeping, fatigue, hair loss, headaches, low sex drive, mood changes, depression, or anxiety, memory problems, swollen or tender breasts, noncancerous breast lumps, or uterine fibroids.

In males, symptoms of high estrogen include erectile dysfunction, enlarged breasts (gynecomastia) and infertility.
High estrogen can also increase the risk of developing thyroid disease, blood clots, heart attack, stroke, breast cancer, or ovarian cancer. Some research suggests that men with high estrogen levels may experience depression.

Medications that can increase estrogen levels include hormonal contraceptives, certain antibiotics, some herbal or natural remedies, and phenothiazines (used for emotional disorders).

Estrogen levels vary according to a person’s age and sex. These levels also fluctuate throughout the menstrual cycle. The three forms of estrogen are estradiol, estriol and estrone. Estradiol is the primary form of estrogen.

Friday, October 19, 2018

What is Wryneck and How is it Treated?

Wryneck occurs when the neck muscles twist beyond their usual capacity, causing the head to tilt. The condition is also known as torticollis or loxia.

Wryneck may develop over time. It can also occur after an injury to the area, or because of a reaction to medication. A person with wryneck may find it uncomfortable or painful to put their head up straight or bend their neck to the unaffected side. It is common in infants, with some sources reporting that it affects 3 in every 100 babies. In most infants, the condition is easily treatable.

Benign paroxysmal torticollis of infancy (BPTI) is a much rarer medical disorder in infants where the baby experiences recurrent episodes of the head tilting to on side.

Some of the [common] causes of wryneck are injury to the neck or spine causing muscle spasm, infection of the head or neck, abscess in the throat or upper airway, and infections in other parts of the body, such as ears, sinuses, jaw teeth or scalp. Less common causes include scar tissue, cervical arthritis, vascular abnormalities, certain medications, and tumors.

Temporary torticollis will usually only affect a person for 1-2 days before disappearing. Those affected may need to rest while keeping their neck as still as possible.

Fixed torticollis occurs because of an underlying problem with a person’s muscles or bone structure. It can also develop if a tumor is growing in the spinal cord, putting pressure on the nerves in the area. Muscular torticollis is the most common form of fixed torticollis. It happens when the muscles on one side of the neck are particularly tight.

The doctor may request X-rays of the neck or a CT scan to diagnose the cause of wryneck.

Wednesday, October 17, 2018

Wisdom Wednesday: ‘Winter Blues’ Study Fined Key to Depression Resilience


A new study used a model of seasonal affective disorder to find out why some people don’t develop depression despite being genetically predisposed. The findings also shed light on potential new treatments for seasonal depression.

The National Institute of Mental Health estimate that over 16 million people in the United States, or 6.7% of the population, will have had more than one episode of major depression during the past year. A further 5% live with seasonal affective disorder (SAD), or seasonal depression. The symptoms of SAD are so similar to those of depression that it can sometimes be hard to distinguish between the two.

SAD, also known as winter blues, typically affects women. In fact, 4 in 5 people with the condition are women, and the reasons for this predisposition are likely to be genetic. However, while some people are genetically prone to the condition, they resist the environmental factors that might trigger it.

So, new research set out to examine the neurobiology of SAD in an attempt to understand what it actually is that makes some people more resilient to developing depression. The new study was led by Dr. Brenda McMahon, of Rigshospitalet in Copenhagen, Denmark, and the findings were published in the journal European Neuropsycholpharmacology.

As Dr. McMahon and her colleagues explain, seasonal depression is caused by insufficient daylight, making the condition more widespread in countries that are father from the Equator. She says, “Daylight is effectively a natural antidepressant. Like many drugs currently used against depression, more daylight prevents serotonin [from] being removed from the brain.

Previous studies had demonstrated that SAD tends to affect people with a gene called 5-HTTLPR. This gene encodes a cerebral serotonin transporter, a protein that regulates how efficiently serotonin – the so-called happiness neurotransmitter – is removed from the brain.

For the new study, Dr. McMahon and team recruited 23 participants – 13 of whom were women – who had not developed depression despite having the 5-HTTLPR gene. The scientists used positron emission tomography (PET) to scan once in the summer and twice in the winter to examine the participants’ levels of both serotonin and serotonin transporter.

Monday, October 15, 2018

Vitamin A supplements could harm bone health

Vitamin A is a vital nutrient that supports the body’s development and strengthens the immune system. Because our bodies do not naturally produce vitamin A, some choose to take supplements. However, too much vitamin A is likely to harm bone health, researchers warn.

Normally, we derive vitamin A form the food we eat, such as carrots, sweet potatoes, beef liver, salmon, and several dairy products. How much vitamin A someone needs depends on their age, as well as other factors. The National Institutes of Health (NIH) state that the ideal daily intake of vitamin A is 900 micrograms retinol activity equivalents for men and 700 mcg RAE for women aged 19-50.

Over time, supplementation of vitamin A might lead to an overload of this nutrient, which can actually increase a person’s risk of experiencing bone fractures. Researchers from the Sahlgrenska Academy at the University of Gothenburg in Sweden reported in the Journal of Endocrinology that taking too much vitamin A can make bones “thin out,” thereby putting them at risk of fracturing easy.

Dr. Ulf Lerner and team administered doses of vitamin A the equivalent of 4.5-13 times the RDA for humans – for 1, 4, or 10 weeks. The scientists saw that after only 8 days of oversupplementation, the mice’s bone thickness had started to decrease. Over 10 weeks, the rodents’ bones became increasingly fragile and prone to fracturing.

Friday, October 12, 2018

Coconut Water

Coconut water is the clear liquid found inside immature coconuts. As the coconut matures, the water is replaced by coconut meat. Coconut water is sometimes referred to as green coconut water because the immature coconuts are green in color.

Coconut water is different than coconut milk. Coconut milk is produced from an emulsion of the grated meat of a mature coconut. Coconut water is commonly used as a beverage and as a solution for treating dehydration related to diarrhea or exercise. It is also tried for high blood pressure and to improve exercise performance.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly ineffective, Likely ineffective, ineffective, and Insufficient Evidence to Rate.

Insufficient evidence to rate effectiveness for coconut water was found for diarrhea-related dehydration, dehydration caused by exercise, exercise performance, high blood pressure, or other conditions.

Coconut water is rich in carbohydrates and electrolytes such as potassium, sodium, and magnesium. Because of this electrolyte composition, there is a lot of interest in using coconut water to treat and prevent dehydration. But some experts suggest that the electrolytes composition in coconut water is not adequate to be used as a rehydration solution.

Wednesday, October 10, 2018

Wisdom Wednesday: Therapeutic Fasting Could Be an Alternative to Insulin for Some Diabetes Patients


Medically supervised fasting could eliminate the need for insulin in some patients with type 2 diabetes, according to findings in BMJ Case Reports.

Three men who'd had type 2 diabetes for 10 to 25 years — and who were taking various pharmacotherapies, including insulin — underwent nutritional training and were instructed to fast for 24 hours three times a week for several months. On fasting days, they ate just dinner. On nonfasting days, they ate lunch and dinner. Low-carbohydrate meals were advised, and participants were seen twice a month for lab testing.

Among the findings:
  • All three patients were able to discontinue insulin within 5 to 18 days. Two ultimately stopped all diabetes medications.
  • All participants saw reductions in hemoglobin A1c, and none experienced symptoms of hypoglycemia.
  • All three lost weight (10%–18% of body weight) and reduced their waist circumference.
  • Patients described feeling "terrific" and "excellent" on fasting days.
  • The researchers write, "Educating patients on the benefits of fasting ... may aid in the remission of (diabetes) and curtail the use of pharmacological interventions."


My Take:
As you know from previous blogs, I have been recommending intermittent fasting for a few of my patients. Most commonly, I recommend the 18-6 fast where you eat from noon to 6 pm and fast the rest of the day and night. In this case study they used the intermittent 24 hour fast. I typically limit this fast to two non-consecutive days a week. However, extreme health issues like chronic, insulin dependent type II diabetes often calls for extreme measures. In this scenario, fasting three days per week is warranted.

Monday, October 8, 2018

Perimenopause & the Adrenal Connection

Last weekend I attended a seminar on understanding the rise and fall of hormones during perimenopause presented by Annette Kutz Schippel, DC. She practices nutrition and chiropractic in Illinois, specializing in women’s issues and pediatrics.

This is the third seminar I have taken with her. Her style is casual and easy going but she has a wealth of knowledge. This class completes my continuing education requirements for 2018 as a diplomate in nutrition. I have the choice of attending a couple of classes each year or presenting a paper for publication. Although I enjoy the challenge of writing, especially when it has to meet the requirements of peer review, I never seem to find the time.

I’ve attended several seminars on women’s health issues, particularly on menopause. However, this is the first that focused on perimenopause and, no pun intended, it did really fill in a gap.

As women enter perimenopause, hormone levels begin to fluctuate outside the normal ovulation cycle. This transition typically begins 2-3 years prior to menopause, but can start as much as 8-10 years before true menopause. By definition, menopause officially begins after menstruation has ceased for a full year.

During this transition women often experience heavier than normal bleeding, irregularity of the cycle, insomnia, depression, mood swings, weight gain, menstrual migraines, decreased fertility, decreased libido, bladder problems, fatigue, hot flashes, vaginal dryness, and more frequent illness.

Common treatment options are oral birth control, often prescribed to be taken continuously, progestin therapy, endometrial ablation surgery, bioidentical hormone treatment, partial or complete hysterectomy and/or increased use of anti-anxiety and anti-depressant medications.

Stress plays a large role in the severity of symptoms and typically the more severe the symptoms of perimenopause, the more severe her symptoms will be during menopause. This is because the adrenal glands, your organs that respond to stress, now have the additional burden of trying to make up for declining hormone production from the ovaries.

Friday, October 5, 2018

Can some foods reduce estrogen in men?

Estrogen and testosterone are hormones that occur naturally in male and female bodies. Some research suggests that certain foods can influence the levels of these hormones.

A 2016 study reports that testosterone levels decline by 0.4-2.0% each year after the age of 30. In some men, this decline leads to depression, reduced libido, erectile dysfunction, and low energy. When a man has a low level of testosterone, a doctor may recommend testosterone injections.

Estrogen is [also] vital for men’s health. It supports the functioning of almost every area of the body, including the brain, heart, bones, muscles, and the immune system. However, if a man’s estrogen levels are too high, this can cause a number of health problems, including obesity and depression.

A handful of studies have suggested that specific foods can raise or lower estrogen levels. However, scant evidence suggests that these foods can address the health effects of high estrogen. Some research suggests that the naturally occurring estrogens in plants, for example, do not affect levels of the hormone in male bodies. The research that suggests certain foods may be able to diminish the level of estrogen is often low-quality or has involved animals rather than humans.

Soy-based products, including edamame and some meat substitutes, are especially rich in plant estrogens. These phytoestrogens are weaker than estrogens that the body produces. When plant estrogens enter the body’s cells, they push out the body’s own estrogens. In this way, consuming more phytoestrogens could lower a person’s estrogen level.

Cruciferous vegetables also contain high levels of phytoestrogens and isoflavones. Results of several studies suggest that isoflavones may prevent the body from converting testosterone to estrogen.

Wednesday, October 3, 2018

Wisdom Wednesday: Does Glucosamine Work?


Glucosamine is a naturally occurring compound that is chemically classified as an amino sugar. It serves as a building block for a variety of functional molecules in your body but is primarily recognized for developing and maintaining cartilage within your joints.

Some studies indicate that supplemental glucosamine may protect joint tissue by preventing the breakdown of cartilage. One small study in 41 cyclists found that supplementing with up to 3 grams of glucosamine daily reduce collagen degradation in the knees by 27% compared to 8% in the placebo group. Another small study found a significantly reduced ratio of collagen-breakdown to collagen-synthesis markers in articular joints of soccer players treated with 3 grams of glucosamine daily over a three-month period.

Multiple studies indicate that supplementing daily with glucosamine sulfate may offer effective, long-term treatment for osteoarthritis by providing a significant reduction in pain, maintenance of joint space and overall slowing of disease progression.

Some studies have revealed significantly reduced markers of rheumatoid arthritis (RA) in mice treated with various forms of glucosamine. Conversely, one human study didn’t show any major changes in RA progression with the use of glucosamine. However, study participants reported significantly improved symptom management.

Monday, October 1, 2018

How cannabinoid drugs affect the experience of pain

A first-of-its-kind meta-analysis of existing research has reviewed the effects of cannabinoid drugs on the experience of pain.

The Centers of Disease Control and Prevention (CDC) suggest that up to 50 million people in the United States have chronic pain. An increasing amount of people now turn to the medicinal benefits of cannabis for treating and alleviating pain. As a result, scientists are trying to keep up by studying the effects of cannabinoids on pain. So far, however, studies have produced mixed results. A recent study that spanned over 4 years found “no evidence” that cannabis alleviates chronic pain that is not associated with cancer.

New research puts forth an interesting explanation for why the current clinical evidence does not fully support the popularity of cannabis as a painkiller and people’s subjective accounts of its benefits. It may be that the “feel-good” factor in the use of cannabis and cannabinoid drugs makes pain “more tolerable” and “less unpleasant,” suggests the new study, and that the benefits of cannabinoid drugs may operate more on an affective level rather than a sensory one.

To help clarify the analgesic properties, Martin De vita, a doctoral researcher at Syracuse University and colleagues examined over 1,830 experimental studies on the effects of cannabinoids that were carried out over a 40-year period. The study was recently published in the journal JAMA Psychiatry.

The results revealed that cannabinoid drugs correlated with “modest increases in experimental pain threshold and tolerance,” and a reduction in the “perceived unpleasantness of painful stimuli.”

Friday, September 28, 2018

What are the best sources of omega-3?

Omega-3 fatty acids are a healthful and essential type of fat, and they offer many health benefits. Fatty fish is an excellent dietary source of omega-3. People can also meet the recommended omega-3 intake by eating plant-based foods, including omega-3 rich vegetables, nuts, and seeds.

There are three main types of omega-3 fatty acid, which are called ALA, DHA, and EPA. Plant sources rich in ALA, while fish, seaweed, and algae provide DHA and EPA fatty acids.

The following types of fish are some of the best sources of these fatty acids. The serving sizes for each is 3 ounces:
  • Mackerel – 0.59 g of DHA and 0.43 g of EPA
  • Salmon – Farm 1.24 g of DHA & 0.59 EPA Wild 1.22 g of DHA & 0.35 g of EPA
  • Seabass – 0.47 g of DHA and 0.18 g of EPA
  • Oysters – 0.14 g of ALA, 0.23 g of DHA and 0.30 g of EPA
  • Sardines – 0.74 g of DHA and 0.45 g of EPA
  • Shrimp – 0.12 g of DHA and 0.12 g of EPA
  • Trout – 0.4 g of DHA and 0.40 g of EPA


Vegetarian and vegan sources of omega-3:
Seaweed and algae – seaweed, nori, spirulina, and chlorella are different forms of algae. They are important sources of omega-3 for vegetarians because they are one of the few plant groups that contain DHA and EPA
  • Chia seeds – 5.055 g of ALA per 1-oz serving
  • Hemp seeds – 2.605 g of ALA in every 3 tablespoons
  • Flaxseeds – 6.703 g of ALA per tablespoon
  • Walnuts – 3.346 g of ALA per cup
  • Edamame – a half-cup of frozen edamame beans contains 0.28 g of ALA
  • Kidney beans – 0.10 g of ALA per half-cup
  • Soybean oil – 0.923 g of ALA per tablespoon


Omega-3 supplementation:
  • Fish oil – the most common omega-3 supplement, offering the highest available dose. Fish oil supplements include both DHA and EPA.
  • Cod liver oil – rich in DHA, EPA, vitamin A and D
  • Krill oil – rich in DHA and EPA
  • Algae oil – for vegetarians, algae oils are an excellent source of omega-3s. However, they contain a lower dose than most fish oil supplements. Some brands include only DHA.
  • ALA supplements – Flaxseed, chia seed, and hemp seed supplements contain only the plant-based omega-3 ALA, which is not sufficient on its own.

My Take:
This is a fairly comprehensive list of sources rich in omega-3 fatty acids. As noted, they are essential as the human body cannot manufacture omega-3 fatty acids. However, we can convert ALA to both DHA and EPA, if our diet is clean enough. That is fortunate for vegans and vegetarians as DHA and EPA are the forms of omega-3 fatty acids most commonly used by the body.

Bottom Line:
The article doesn’t mention a recommended daily intake. I suggest a minimum of 2 grams of omega-3 fatty acids daily with about 400 mg of DHA and EPA. You can easily meet that standard with a fresh serving of fish daily. Otherwise, I recommend a supplement daily.

Source: September 23. 2018 NIH

Wednesday, September 26, 2018

Wisdom Wednesday: What does it mean if your ESR is high?


The ESR test measures the erythrocyte sedimentation rate, which is how quickly red blood cells settle at the bottom of a blood sample. Doctors cannot use the results of the test to diagnose specific disease because many different health conditions can cause the ESR to be high or low.

Doctors call the ESR test a nonspecific test, as it only confirms the presence or absence of inflammatory activity in the body. Doctors typically use other lab tests, clinical findings, and the person’s health history alongside ESR test results to make a diagnosis.

Inflammation usually occurs in the body as a result of underlying medical conditions, such as infection, cancer, or an autoimmune disease. Doctors also use the ESR to monitor conditions like RA, temporal arteritis, polymyalgia rheumatica and systemic vasculitis are responding to treatment.

A small amount of blood is drawn and transferred to a vertical test tube in which the red blood cells will slowly settle at the bottom. This will leave a clear, yellowish fluid at the top, the plasma. The result of the ESR test is the amount of plasma remaining at the top of the test tube after 1 hour.

Red blood cells settle at a faster rate in people with inflammatory conditions. Inflammation increases the number of proteins in the blood and causes red blood cells to clump together and settle more quickly.

Monday, September 24, 2018

Breast Milk Provides Food Allergy Protection

Replicating the nourishment found in mother’s milk has been a challenge, especially since science continues to reveal its complex composition. Previous research indicates breastfed children have a lower risk of certain medical conditions, such as wheezing, infections, asthma and obesity. Identifying specific components that influence immunity is key to identifying a potential for therapeutic interventions.

A recent study hypothesized that “sensitization resulting from the composition of complex sugars in breast milk [could possibly] prevent future food allergies,” and this hypothesis was verified in 1-year-old infants (N=421). Human milk oligosaccharides (HMOs) are structurally complicated sugar molecules unique to breast milk. Classified as “the third most abundant solid component in human milk after lactose and fat,” they are indigestible, but play a key prebiotic role and help develop the infant’s gut microbiota.

This team found that the overall HMO composition appeared to play a role in food sensitization, however, “no individual HMO was as yet associated with food sensitization.”  Even though the composition of HMOs in breast milk varies depending on the lactation stage, gestational age, maternal health, ethnicity, geographic location and whether or not the mother is breastfeeding exclusively, a beneficial HMO profile was associated with a lower rate of food sensitization in children at one year.

Friday, September 21, 2018

Can eating this type of sugar prevent weight gain?

Mannose, a type of sugar, can greatly affect metabolism, weight gain, and the composition of gut bacteria in rodents. This result may lead to new treatments and prevention strategies for both obesity and weight gain.

More and more studies are unraveling the multi-layered relationship between our gut microbiome and weight gain. A few years ago, a twin study that Medical News Today reported on found that genes influence the bacteria that live in our gut, which, in turn, influence whether we gain weight or not. Another paper proposed that our diets influence our guts’ “power” to decide how much weight we gain.

Belly fat – the most harmful type of fat – in particular is known to be driven by our gut bacteria, but the food that we eat, this study suggested, plays a more important role in these weight-regulating gut processes than genes. New research brings further nuance to this latter idea. Specifically, a new study looks at how the intake of mannose, a type of sugar, affects the gut bacteria and weight gain in mice.

Hudson Freeze, Ph.D., director of the Human Genetics Program at the Sanford Burnham Prebys Medical Discovery Institute in San Diego, CA, and colleagues observed the effects of mannose on weight gain while they were studying its’ therapeutic effects on CDG (congenital glycosylation). Then the team decided to investigate the effects of mannose further.

The study revealed that mice that were fed a high-fat diet plus mannose were leaner, had less fat in their livers, were more tolerant to glucose, and had overall higher levels of fitness than mice that had the mannose-free diet.

Wednesday, September 19, 2018

Wisdom Wednesday: What allows C. difficile to survive so well in the gut?


Clostridium difficile is a particularly hardy type of bacteria, which is very difficult to treat. It often affects people during a hospital stay – especially if they have taken antibiotics. Why is it this resilient, and does knowing this lead to better treatments?

According to some experts, Clostridium difficile infections are ever on the rise and becoming increasingly difficult to treat. This means that researchers need to find new and better ways of targeting this stubborn bacterium. Among other symptoms, C. difficile can cause diarrhea, which can range from mild to extremely severe. In the most extreme cases, the infection can even lead to death.

Recently, a team from the London School of Hygiene and Tropical Medicine in the United Kingdom made a new and important discovery: C. difficile releases a special compound that allows it to gain ground over gut bacteria and to establish a strong presence in the gut environment. This findings are now published in the journal PLOS Pathogens.

C. difficile infections often appear after a person has followed a treatment with antibiotics, because these drugs work by essentially killing bacteria. Unfortunately, antibiotic do not only destroy the bacteria that cause harm.

Antibiotics also disrupt the balance of the gut microbiota, which contains many types of bacteria that are harmless and promote or sustain the health of the intestines. When this happens, C. difficile sometimes takes hold – and fighting it is often very complicated.

For the first time, researcher Lisa Dawson and team found that the release of para-cresol by C. difficile affects the growth of many microorganisms in the gut and allows it to prevail over other bacteria.

Monday, September 17, 2018

LDL More Than 160 Tied to Increased Mortality in Low-Risk Patients

Patients deemed at low-risk for cardiovascular disease (CVD) but with LDL levels above 160 face increased mortality risks over the long term, a Circulation study suggests.

Over 36,000 adults in Texas (median age, 42) with an estimated 10-year risk for atherosclerotic CVD events below 7.5% had their lipid levels measured and were followed for a median of 27 years. During that time, nearly 1100 CVD deaths and 600 coronary heart disease (CHD) deaths occurred.

After multivariable adjustment, participants with LDL levels of 160–189 mg dL had a 70% increased risk for CVD mortality and more than twice the risk for CHD mortality, relative to those with LDL below 100 mg dL. Increasing levels of non-HDL cholesterol were also associated with higher mortality risks.

The researchers note that 2013 cholesterol guidelines recommend statins for low-risk patients when LDL reaches 190 mg dL, with a class IIb recommendation for considering treatment at 160 mg dL. They say their current findings "suggest a stronger consideration of using the LDL-C greater than 160 mg dL cutoff."

My Take:
The medical norms for LDL are less than 130 mg dl. However, many labs list the medical norm as less than 100 mg dl as that is the goal of statin drug therapy. Many physicians like to drive the LDL level less than 60 mg dl, although the research indicates no additional benefit in cardiovascular risk is associated with this goal.

Friday, September 14, 2018

Nutrition and Functional Neurology: Partners in Holistic Patient Care

Sweeping through models of chiropractic care, functional neurology is transitioning away from the limited concept of vertebral fixations to embracing the concept of neural tone, championed by the very originator of chiropractic – D.D. Palmer. Indeed, the updated definition of subluxation put forth by the Council for Chiropractic Practice in 2013 plainly states that subluxation is “a neurological imbalance or distortion in the body associated with adverse physiological responses and/or structural changes which may become persistent or progressive.” Following this line of reasoning, functional neurology opens the discussion to a range of causes of the neurological imbalances, including (i) inflammation, (ii) nutritional problems, (iii) hormonal imbalances, (iv) emotional stress, and (v) structural derangements that dominated earlier models of chiropractic interventions.

The positive aspect of functional neurology is its reorganization of nerve cells, making possible the restoration or bypass of connections that have become disrupted or damaged. A perfect example would be performing exercises to recover from [a] stroke. The negative aspect of functional neurology, however, is that if a neuronal pathway is not fired, synaptic connections may become inactive with the loss or inactivation of neurotransmitters and receptors, as exemplified by the risk of cognitive decline in the elderly and the undertaking of exercise to counteract that effect. Both of these transformations of nervous system activity have become known as neuroplasticity, not limited to neural injury or recovery but also including the remodeling of dendrites, synapse turnover, long-term potentiation, and neurogenesis. One striking example out of many demonstrating the phenomenon of neuroplasticity was offered by an observational study of London cab drivers, in which there was a redistribution of gray matter in their brains as they became familiar with the city’s layout.

Wednesday, September 12, 2018

Wisdom Wednesday: The Dirty Dozen


Every year, the Environmental Working Group (EWG) releases the “Dirty Dozen” – a list of the 12 non-organic fruits and vegetables highest in pesticide residues.

Pesticides are substances commonly used in agriculture to protect drops from damage caused by insects, weed pressure and diseases. To compile the Dirty Dozen list, the EWG analyzes over 38,000 samples taken by the USDA and FDA to single out the worst offenders.

While the EWG claims that this list can help consumers avoid unnecessary pesticide exposure, some experts – including food scientists – argue that the list is scaring the public away from consuming healthy foods.

Pesticides are tightly regulated by the USDA, and recent reports indicate that pesticide levels found on 99.5% of conventional produce are well below recommendations set by the EPA. The USDA Pesticide Data Program ensures that the U.S. food supply “is one of the safest in the world,” due to rigorous testing methods.

However, many experts argue that continuous exposure to pesticides – even in small doses – can build up in your body overtime and lead to chronic health conditions.

Additionally, there is concern that the safe limits set by regulatory agencies don’t take into consideration the health risks involved with consuming more than one pesticide at a time.

Monday, September 10, 2018

The Man Who Sold America On Vitamin D – And Profited in the Process

Dr. Michael Holick’s enthusiasm for vitamin D can be fairly described as extreme. The Boston University endocrinologist, who perhaps more than anyone else is responsible for creating a billion-dollar vitamin D sales and testing juggernaut, elevates his low levels of the stuff with supplements and fortified milk. When he bikes outdoors, he won’t put sunscreen on his limbs. He has written book-length odes to vitamin D, and has warned in multiple scholarly articles about a “vitamin D deficiency pandemic” that explains disease and suboptimal health across the world.

His fixation is so intense that it extends to the dinosaurs. What if the real problem with that asteroid 65 million years ago wasn’t a lack of food, but the weak bones that follow a lack of sunlight? “I sometimes wonder,” Holick has written, “did the dinosaurs die of rickets and osteomalacia?”

Holick’s role in drafting national vitamin D guidelines, and the embrace of his message by mainstream doctors and wellness gurus alike, have helped push supplement sales to $936 million in 2017. That’s a ninefold increase over the previous decade. Lab tests for vitamin D deficiency have spiked, too. Doctors ordered more than 10 million for Medicare patients in 2016, up 547% since 2007, at a cost of $365 million. About 1 in 4 adults 60 and older now take vitamin D supplements.

But few of the Americans swept up in the vitamin D craze are likely aware that the industry has sent a lot of money Holick’s way. A Kaiser Health News investigation found that he has used his prominent position in the medical community to promote practices that financially benefit corporations that have given him hundreds of thousands of dollars – including drugmakers, the indoor-tanning industry and one of the country’s largest commercial labs.

In an interview, Holick acknowledged he has worked as a consultant to Quest Diagnostics, which performs vitamin D tests since 1979. Holick, 72, said that industry funding “doesn’t influence me in terms of talking about the health benefits of vitamin D.”

Friday, September 7, 2018

“Transparency” as Mask? The EPA’s Proposed Rule on Scientific Data

The Environmental Protection Agency (EPA) recently proposed excluding from consideration in setting environmental standards any studies whose raw, individual-level data are not publicly available. This proposal was preceded by the wholesale exclusion from the EPA’s scientific advisory boards of academic scientists who receive research grants from the agency – and their replacement by industry-funded scientists. It is hard to interpret these actions as anything other than an attack on the use of hard scientific evidence to set environmental standards.

Open science has growing support, and justly so. However, studies conducted at academic institutions and involving humans, which are regulated by the Health Insurance Portability and Accountability Act (HIPPAA) and institutional review boards (IRBs), must maintain a basic regard for privacy. Great progress in understanding pollution’s effects has been made by adding exposure information to large cohort studies that were established to explore cardiovascular disease or cancer. Such studies have been used, for example, to analyze concentrations of metals in blood, urine, or toenails and to attribute air pollution exposure to people according to their residential address. Precisely because these studies include measurements of many potential confounding factors, it is difficult to make the data public without also making participants identifiable. For example, after Hurricane Katrina, a local newspaper published a map of the locations of deaths. It showed no roads, and the only geographic data included were neighborhoods. Yet researchers were able to correctly identify the residential address for most of the people who died.

It is difficult to believe that EPA leaders do not know that few human cohort studies could comply with their requirements – and therefore difficult not to conclude that the real purpose of the proposal is to eliminate a vast body of highly relevant data from consideration, resulting in a weakening of standards that are no longer supported by “sufficient scientific evidence.”

My Take:
The attacks on science in the current political climate are real and dangerous. The EPA has been under a gag order since the new administration took office. Please read my blog “Chemicals Found in Many U.S. Streams” posted on April 28, 2017. Just enter “EPA” in the search box in the upper left hand corner of my blog page. This study was completed prior to the gag order but published after the gag order with no comment from the EPA who sponsored the study.

Bottom Line:
This anti-science trend is reminiscent of my high school world history class study on the Dark Ages. I have always found it hard to believe that people could be so ignorant, even a thousand years ago. Those that ignore history are doomed to repeat it.

Source: August 30, 2018 The New England Journal of Medicine

Wednesday, September 5, 2018

Wisdom Wednesday: A Soy-based Diet Could Help Strengthen Bones


A new study has investigated the impact of dietary soy on bone strength in postmenopausal women. The authors conclude that eating more soy might in fact strengthen bones in women of all ages.

The reduction in bone density and strength that is common in postmenopausal women is of huge concern. As women age, osteoporosis, reduced activity levels, and weight gain act together to decrease bone health and negatively impact metabolism. Osteoporosis and bone weakness increases the risk of fractures, which then lead to even more inactivity and weight gain, exacerbating the issue further. As the population becomes – on average – older and heavier, bone health is an important area of medical science to study.

To investigate, researchers from the University of Missouri in Columbia utilized so-called low-capacity running rats, which have lower fitness levels.

The researchers surgically removed the ovaries of half of the rats to mimic menopause. The scientists fed half of the rats a soy-based diet and the remaining animals a corn-based diet. Both diets contained the same amount of calories. They weighed the rats every week for the duration of the 30-week trial.

Then, the team took blood samples, tested bone strength, and assessed body composition. The analysis showed that, although turnover markers were not significantly altered, the leg bones of soy-fed rats were stronger than the bones of the rats that were fed a corn-based diets.

Friday, August 31, 2018

Daily Aspirin Unwise for Most

Taking a low-dose aspirin every day has long been known to cut the chances of another heart attack, stroke or other heart problem in people who already have had one, but the risks don’t outweigh the benefits for most other folks, major new research finds.

The research was discussed Sunday at the European Society of Cardiology meeting in Munich.

A Boston-led study gave aspirin or dummy pills to 12,546 people who were thought to have a moderate risk of suffering a heart attack or stroke within a decade because of other health issues.

After five years, 4% of each group had suffered a heart problem. One percent of aspirin takers had stomach or intestinal bleeding, mostly mild – twice as many as those on dummy pills. Aspirin users also had more nosebleeds, indigestion, reflux or belly pain. Bayer sponsored the study, and many researchers consult for the aspirin maker. Results were published by the journal Lancet.

Oxford researchers randomly assigned 15,480 adults with Type 1 or 2 diabetes but otherwise in good health and with no history of heart problems to take aspirin, 1 gram of fish oil, both substances, or dummy pills daily. After 7.5 years, there were fewer heart problems among aspirin users but more cases of serious bleeding, so they largely traded one risk for another.

The same study also tested omega-3 fatty acids, good oils found in salmon, tuna and other fish. Supplement takers fared no better than those given dummy capsules: 9% of each group suffered a heart problem. “We feel very confident that there doesn’t seem to be a role for fish oil supplements for preventing heart disease,” said University of Oxford’s Dr. Louise Bowman, study leader.

Wednesday, August 29, 2018

Wisdom Wednesday: Pesticide Linked to Autism


Abstract
Objective:

Autism is a complex neurodevelopmental disorder with a largely unknown etiology. To date, few studies have investigated prenatal exposure to toxins and risk of autism by using maternal biomarkers of exposure. Persistent organic pollutants are lipophilic halogenated organic compounds and include the insecticide dichlorodiphenyltrichloroethane (DDT), as well as its metabolite p,p′-dichlorodiphenyl dichloroethylene (p,p′-DDE), and polychlorinated biphenyls (PCBs). The objective of this study was to test whether elevated maternal levels of persistent organic pollutants are associated with autism among offspring.

Method:
The investigation was derived from the Finnish Prenatal Study of Autism, a national birth cohort study based on a nested case-control design. Cases of autism among children born between 1987 and 2005 were ascertained by national registry linkages. In cases of childhood autism and matched control subjects (778 matched case-control pairs), maternal serum specimens from early pregnancy were assayed for levels of p,p′-DDE and total levels of PCBs.

Results:
The odds of autism among offspring were significantly increased with maternal p,p′-DDE levels that were in the highest 75th percentile, with adjustment for maternal age, parity, and history of psychiatric disorders (odds ratio=1.32, 95% CI=1.02, 1.71). The odds of autism with intellectual disability were increased by greater than twofold with maternal p,p′-DDE levels above this threshold (odds ratio=2.21, 95% CI=1.32, 3.69). There was no association between total levels of maternal PCBs and autism.

Conclusions:
These findings provide the first biomarker-based evidence that maternal exposure to insecticides is associated with autism among offspring. Although further research is necessary to replicate this finding, this study has implications for the prevention of autism and may provide a better understanding of its pathogenesis.

My Take:
Although DDT was banned in the United States in 1972, it still remains in our environment, along with all its’ metabolites. It is still used in many parts of the world and limited uses in the US continue under “public health exception, for emergency agricultural use.” This continued use is not well publicized.

The half-life for DDT is 2-15 years with 97% of it degraded after 5 half-lives. It stores in the fatty tissues of our bodies and has been linked with Alzheimer’s disease, MS and other chronic degenerative conditions.

Clinically, I find reflex testing for both DDT and Round Up quite often. Both of these toxic chemicals are in all of us. It appears that DDT predominates in my older patients while Round Up shows up in younger patients. The real question is do these toxins need to be removed from the body? More and more, the answer is yes, although it often is not the first priority.

Bottom Line:
Autism is multifactorial but I strongly suspect that environmental toxins are a major factor in the dramatic increase in the rate of autism worldwide.


Monday, August 27, 2018

It’s All About the Bass

Music is almost universal. Every society on earth has music blended into its culture, and music, inevitably, brings dance.
But why are we so driven to move out limbs, heads, and bodies to rhythmic sounds? A facet of music that often goes hand in hand with dancing is the heavy use of bass. Be it the beat of a drum or the pulsing sound from a subwoofer, the bass is often a driving factor in our desire to move in time with the music.

A new study set out to investigate music and the brain, and although it does not fully answer the questions above, it does give new insight into music and the human experience. The results were published this week in the journal PNAS.

The scientists – from Western Sydney University’s MARCS Institute in Australia – were particularly interested in the way that our brains process low-frequency sounds. The scientists played each participant rhythmic patterns, in either a high- or low-pitched tone, and recorded the electrical activity of the person’s brain using electroencephalography (EEG). They found that brain activity became synchronized with the frequency of the beat.

In the current study, however, they found that bass-heavy music was more successful at locking the brain into the rhythm. The lower frequencies, it seems, strong-arm the brain into synchronizing. The lower frequencies, as the authors write, boost “selective neural locking to the beat.”

The authors theorize that the synchronizing effect that bass has on the brain could be due to “a greater recruitment of brain structures involved in movement planning and control,” such as the cerebellum and basal ganglia.

Friday, August 24, 2018

A2 Milk: Breakthrough of Science or Marketing?

Shoppers in the United States are about to encounter something new in the dairy aisle. A2 milk, a substitute for conventional milk successfully launched in New Zealand two decades ago, is hoping the win over American consumers with an expansive pitch of health claims.

Advocates of A2 mild don’t just see it as the next almond or soy milk. Instead, they’re positioning it as an alternative to one of Western society’s foundational food sources, which they believe has had an outsized role in causing maladies ranging from simple indigestion to cardiovascular disease, autism, and schizophrenia.

These claims have been met in equal measure by critics who have identified A2 milk as something more conventional – a hype-driven product building a profitable foundation on limited science.

Beta-casein is the major source of protein in mild. Around 8000 year ago however, the characteristics of beta-casein began to change, with a lone mutation occurring at one of the 209 amino acids in its genetic profile. Breeding practices and random acts of history made A1-production cows the norm in Europe and, subsequently, the majority of the Western world.

The difference is potentially important because digesting A1, but not A2, beta-casein can cause the release of the opioid beta-casomorphin (BCM-7) in the small intestine. BCM-7 has been linked to impaired gastrointestinal function, such as decreased intestinal contractions and suppressed lymphocyte proliferation.

Many studies on the risks of A1 milk are from animal study data and causal associations showing higher rates of chronic disease in countries primarily reliant on A1 milk. Researchers have used both to establish a link between A1 milk consumption and an elevated risk for gastrointestinal impairment, type 1 diabetes, coronary heart disease, and perhaps further afield, autism and schizophrenia.

Many of these studies have been knocked for being funded by the A2 Milk Company, the main producer of this product. In a turnaround befitting the tit-for-tat nature of this debate, the author of a 2006 critical review that found “no convincing or even probable evidence” of A1’s harmful effects in humans was later found to have been a consultant for a New Zealand dairy company producing A1 milk.

Wednesday, August 22, 2018

Wisdom Wednesday: Homocysteine


A homocysteine test measures the amount of homocysteine in your blood. Homocysteine is a type of amino acid, a chemical your body uses to make proteins. Normally, vitamin B12, vitamin B6 and folic acid break down homocysteine and change it into other substances your body needs. There should be very little homocysteine left in the bloodstream. If you have high levels of homocysteine in your blood, it may be a sign of a vitamin deficiency, heart disease, or a rare inherited disorder.

If your health care provider thinks a vitamin deficiency is the reason for your high homocysteine levels, he of she may recommend dietary changes to address the problem. Eating a balanced diet should ensure you get the right amount of vitamins.

If your health care provider thinks your homocysteine levels put you at risk for heart disease, he or she will monitor your condition and may order more tests.

My Take:
Another “dummied down” press release from NIH. Again, the information is fairly accurate, although misleading. I write about homocysteine frequently. Please review my blog “Cardiovascular Disease: Risk Assessment with Nontraditional Risk Factors” posted on July 13, 2018. This will familiarize you with the cardiac risks associated with homocysteine.

Homocysteine is an intermediate metabolite in the sulfur amino acid pathway. We consume sulfur attached to amino acids, most commonly in cruciferous vegetables like broccoli, cauliflower, arugula, and kale. Methionine (a sulfur bearing amino acid) is converted to SAM-e, a popular nutritional supplement used to calm the brain. SAM-e is then converted to homocysteine.

Monday, August 20, 2018

After Doctors Cut Their Opioids, Patients Turn to a Risky Treatment for Back Pain

An injectable drug that the manufacturer says is too dangerous to use along the spine is growing in popularity for back pain as doctors turn away from opioids.

The anti-inflammatory drug, called Depo-Medrol and made by Pfizer, is approved for the injection into muscles and joints. Once a drug is approved, however, doctors may legally prescribe it however they see fit.

What few doctors or patients know is that Pfizer, faced with hundreds of complaints about injuries and complications related to the shots, asked the Food and Drug Administration to ban that type of treatment five years ago. The company cited the risk of blindness, stroke, paralysis and death – a request that neither the agency nor Pfizer made public.

The FDA declined to issue a ban but toughened the label warning. Other countries – among them Australia, Brazil, Canada, France, Italy, New Zealand and Switzerland – heeded Pfizer’s request.

After concerns were raised about the off-label treatments, use of the injections declined. But the opioid epidemic appears to be spurring their popularity despite risks known to public health officials and doctors.

According the FDA, back problems are the most common cause of disabling, chronic pain. Weekend classes to train physicians in the procedure are flourishing. Critics like Dr. Terri A. Lewis, a rehabilitation specialist and lecturer at the Southern Illinois University, say they are responsible for transforming pain clinics into “drill mills.”

And in June, as part of legislation to tackle the opioid crisis, the House of Representatives approved an increase in Medicare reimbursement for the procedure.

Friday, August 17, 2018

ORIVO Certification

ORIVO provides laboratory services for testing the authenticity of marine ingredients, both oil and meal. The testing technology, initially developed by the Norwegian research organization SINTEF, is based on proven species and region of origin via quality assured sampling protocols. Based in Molde, Norway, ORIVO serves the global markets independent third party verification to meet the consumer demand for non-adulterated and sustainable marine ingredients.

Biotics Research Corporation is the first supplement brand in the United States to provide certification of authenticity to their fish oil products, verified by ORIVO through an independent third-party authenticity test. They use an anchovy source from the cold waters of the South Pacific Ocean off the South American coast.

Customers now can be certain they are getting the highest quality omega-3s available. The certification also shows the fish oil is coming from sustainable sources.

My Take:
SINFEF developed this technology in response to concerns about the quality of omega-3 fatty acids products, most of which come from Norway. In the past, most supplement companies depended on the wholesale manufacturers to provide good quality fish oil.

Reputable supplement companies, like Carlson and Metagenics, would pay the manufacturer to remove any mercury from the raw material. That is how their labels claimed that their products were “mercury free”. Brands that offered low cost fish oil, like Costco, didn’t pay for mercury removal and made no such claims.

However, in 2004, 74 supplement companies were indicted by a judge in California for mercury contamination in products that claimed to be mercury free. The common source was a Norwegian manufacturer who was charging for mercury removal but skipping the high density molecular extraction process needed to remove the mercury.

Wednesday, August 15, 2018

Wisdom Wednesday: C- Reactive Protein (CRP) Test


A C-reactive protein test measures the level of C-reactive protein (CRP) in your blood. CRP is a protein made by your liver. It’s sent into your blood stream in response to inflammation. Inflammation is your body’s way of protecting your tissues if you’ve been injured or have an infection. It can cause pain, redness, and swelling in the injured or affected area. Some autoimmune disorders and chronic diseases can also cause inflammation. Normally, you have low levels of c-reactive protein in your blood. High levels may be [a] sign of a serious infection or other disorder.

If you’ve already been diagnosed with an infection or have a chronic disease, this test may be used to monitor your treatment. CRP levels rise and fall depending on how much inflammation you have. If your CRP levels go down, it’s a sign that your treatment for inflammation is working.

The CRP test is sometimes confused with a high-sensitivity-(hs) CRP test. Although they both measure CRP, they are used to diagnose different conditions. An hs-CRP test measures much lower levels of CRP. It is used to check for risk of heart disease.

My Take:
This is the kind of “dummied-down” information currently being released by NIH (National Institutes of Health) rather than reporting on cutting edge research.

Although the information presented is fairly accurate, it is also misleading. The hs-CRP also measures inflammation but it is specific for vascular inflammation. As such, it can be an indicator of cardiac risk. When elevated, the hs-CRP stimulates LDL cholesterol to bind with homocysteine and create plaque in an inflamed artery wall. At low levels this is a form of repair, protecting the damaged artery from rupture. However, when excessive, artery occlusion or clots can occur resulting in a CVA, stroke or pulmonary embolism.

Monday, August 13, 2018

Salt Restrictions for Some May Be Better Than for All

Restricting sodium intake seems best suited to communities with the highest consumption levels, according to an 18-country study in The Lancet.

Researchers used urine samples from nearly 100,000 adults to estimate sodium and potassium intakes. Blood pressure was also measured, and cardiovascular events were tracked.

Mean sodium intake was 4.8 g per day, with Chinese communities having higher intakes (5.6 g). During a median follow-up of 8 years, a mean increase of 2.86 mm Hg in systolic pressure was noted for every 1-g increase in sodium intake above the overall average. There was a positive association between sodium intake and stroke, but only in communities with the highest sodium intake. Of note, the frequency of cardiovascular events showed an inverse association with sodium intakes in communities with the lowest intakes.

Higher potassium intakes were associated with lower rates of all cardiovascular events.

The authors suggest that targeting restrictions to communities with sodium intakes above 5 g/day would bring the most benefit. Commentators call the findings "exceedingly provocative."

My Take:
WHO recommends that populations consume less than 2 g/day sodium as a preventive measure against cardiovascular disease, but this target has not been achieved in any country. This recommendation is primarily based on individual-level data from short-term trials of blood pressure (BP) without data relating low sodium intake to reduced cardiovascular events from randomized trials or observational studies. Now a new well-designed study questions the wisdoms of this recommendation.

Friday, August 10, 2018

Saunas Linked to Numerous Health Benefits

A stint in a sauna is not only pleasant and relaxing but may also improve health, according to the authors of a new, comprehensive literature review. Among the benefits they identified were a reduced risk for cardiovascular, neurocognitive, and pulmonary illnesses such as asthma and influenza; amelioration of pain conditions such as rheumatic diseases and headache; decreased risk for mortality; and an improved quality of life.

Overall, “the physiological responses produced by an ordinary sauna bath correspond to those produced by moderate or high intensity physical activity such as walking,” Jari A. Laukkanen, MD, PhD, from the Faculty of Sport and Health Sciences, University of Jyvaskyla, Finland, and colleagues write in an article published online July 31 in Mayo Clinic Proceedings. In fact, the advantages of sauna bathing plus physical activity may be additive, they write.

The findings build on earlier research by the same authors linking sauna use to a decreased risk for stroke. In that study, there was an inverse relationship between frequency of weekly sauna visits and stroke rates per 1000 person-years for follow-up. The authors listed a variety of positive effects associated with sauna baths that might account for that finding, including lower blood pressure and improvements in lipid profiles, arterial stiffness, carotid intima-media thickness, and peripheral vascular resistance, as well as a reduced risk for hypertension, dementia, and cardiovascular and all-cause mortality.

They confined the analysis to traditional Finnish sauna baths, as those have been the most widely studied to date. In a Finnish sauna, temperatures range from 176-212 degrees Fahrenheit, with 10-20% relative humidity. A bather will usually spend 5 t0 20 minutes in the sauna and follow it with a swim, a shower, or just a cooling-off period at room temperature, the authors explain. Finnish people typically have “a sauna bath at least once per week, with the average habitual frequency being 2 to 3 times a week.”

Wednesday, August 8, 2018

Wisdom Wednesday: Clinicians Rarely Ask for Patients’ Input, Often Interrupt


During consultations, clinicians rarely ask patients to explain the reasons for their visit, a recent study published online July 2 in the Journal of General Internal Medicine has shown.

“The patient’s agenda was elicited in 36% of the clinical encounters,” writes Naykky Singh Ospina, MD, from the University of Florida, and colleagues. And, “among those in which the agenda was elicited, patients were interrupted seven out of ten times, with a median time to interruption of 11 seconds.”

According to the authors, patient-centered decision-making is a key feature of quality healthcare. In particular, identifying and understanding the patient’s agenda for the visit both improves and facilitates patient-clinician communication, they emphasize.

My Take:
The remainder of the article was devoted to a statistical analysis of the methods used to analyze these videotaped clinician-patient encounters.

I was taught, and still believe, that 80% of a good diagnosis is a detailed history. I often tell my patients who are not forthcoming during consult that without hearing their story I might as well be a vet. Of note, this article was written by Dr. Nicola M Parry, a veterinarian.

In theory, the consult guides your examination and combination of these two elements leads to confirmatory testing. Unfortunately, modern medicine works in reverse. They run a lot of tests and hope to find a diagnosis. Studies indicate that 80% of medical costs incurred by a patient are for diagnostic testing rather than treatment.