Monday, June 11, 2018

‘Millions’ Prescribed Wrong Dose of Common Drugs

According to updated calculations published this week, over 11 million people in the United States may have been given the wrong prescription for a range of commonly used drugs.

Scientists from the Stanford University School of Medicine in California recently investigated the reliability of so-called pooled cohort equations (PCEs). PCEs help doctors to determine each patient’s overall risk of stroke or heart attack. Assessing cardiovascular risk helps to inform the physician about the exact level of medication that will be both effective and safe. These equations are available as online web tools and smartphone apps, and they are even built into digital medical records.

In recent years, some have called into question the accuracy of PCEs, asking whether the data that they rely on are outdated. If this were found to be the case, patients could potentially be at risk of taking dangerously high or ineffectively low doses of drugs.

Dr. Sanjay Basu, Ph.D., an assistant professor of primary care outcomes research at Stanford published his findings this week in the journal Annals of Internal Medicine.

The first issue was updating the data used to derive the equations. Some of the datasets are relatively old. For instance, one included information from people who were aged 30-62 in 1948. Diet, lifestyle and health risks have changed since those days. The study authors say that, because of the age of this information, people’s risks were being estimated at around 20% higher than they truly were. Dr. Basu notes that “relying on our grandparents’ data to make our treatment choices is probably not the best idea.”

“Another issue the researchers identified was the lack of African-Americans in the datasets. It is now known that cardiovascular risk is significantly higher in the African-American population. So, while many Americans were being recommended aggressive treatments that they may not have needed according to current guidelines, some Americans – particularly African-Americans – may have been give false reassurance and probably need to start treatment given our findings.” – Dr. Sanjay Basu, Ph.D.

Friday, June 8, 2018

Is Chemo for Breast Cancer overprescribed?

According to a landmark study, a large percentage of individuals with the most common form of early breast cancer could safely skip chemotherapy. The findings could impact thousands of people each year.

While new therapies such as immunotherapies are becoming increasingly crucial in treating cancer, chemotherapy is still a mainstay. Though chemotherapy is effective, it carries with it a range of significant side effects, such as hair loss, increased risk of bleeding, susceptibility to infection, nausea, vomiting, and anemia. Consequently, chemotherapy is only used when deemed entirely necessary. The challenge lies in determining exactly when it is entirely necessary.

Individuals with breast cancer sometimes have their tumors analyzed using a gene test called the Oncotype DX test. This examines how active 21 specific genes are provides a “recurrence score” of 0-100. When scores are high, chemotherapy will be used following surgery or radiation therapy to lower the risk of the cancer returning. For individuals with low scores, the tumors are considered less dangerous, and chemotherapy is not deemed essential.

This type of testing has proven useful but there is a substantial gray area. As it stands, those who score 1-10 do not receive chemotherapy and those who score above 25 do. The majority of women, however, fall in the intermediate range of 11-25.

To get a better picture of who needs treatment, researchers from Loyola Medicine and Montefiore Medical Center undertook a large-scale investigation. Their findings are now published in the New England Journal of Medicine.

They used data from more than 10,000 women with hormone-receptor-positive, HER-2 negative breast cancer – the most common form of breast cancer, accounting for about half of breast cancer cases in the United States. Of particular interest were the 69% of women who had scored 11-25 on the 21-gene test.

Wednesday, June 6, 2018

Wisdom Wednesday: Plant Pigments May Preserve Lung Function into Old Age

New research finds that flavonoids – which are natural chemical compounds found in plants, such as fruits and vegetables – can help to slow the decline in lung function that tends to occur with age.
As the plants’ pigments, flavonoids are responsible for the vibrant colors of fruits and vegetables. They also attract pollinating insets and regulate cell growth. Research has suggested that dietary flavonoids may hold a lot of benefits for human health.

In vivo and in vitro studies have exposed flavonoids’ range of anti-inflammatory and antidiabetic properties, as well as their anticancer and neuroprotective benefits. New research adds to this list, suggesting that a certain type of flavonoid called “anthocyanins” can help to maintain healthy lung function well into old age.

The research was led by Vanessa Garcia-Larsen, Ph.D., who is an assistant professor in the Human Nutrition Division of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD. The findings were presented at the American Thoracic Society International Conference, held in San Diego, CA.

For this study, the researchers looked at data available from 463 adults from Norway and England – aged 44, on average – who took part in a spirometry test at the beginning of the study and at different follow-up times.

Spirometry is a pulmonary lung function test that measures the airflow and the volume of air that a person can exhale on command.

Additionally, the study participants had filled in a dietary questionnaire, so the researchers were able to divide the participants into quartiles, or fourths, based on their dietary intake of anthocyanins.
The research revealed that the highest quartile of anthocyanin consumers, when compared with the lowest, had a much slower rate of decline in all three aspects of lung function measured by the spirometry.

Monday, June 4, 2018

Pesticides May Cause Parkinson’s in Some People

New research reveals how the pesticides paraquat and maneb alter gene expression and may lead to Parkinson’s disease in people who are genetically predisposed to the illness.

Estimates show that around 50,000 people in the United States are diagnosed with Parkinson’s disease every year. Although it is not exactly known what causes the disease, both genetic and environmental factors are thought to play a critical role.

Senior study author Scott Ryan, a professor of molecular and cellular biology at the University of Guelph in Ontario, Canada explains the motivation behind the research. He notes, “People exposed to these chemicals are at about a 250% higher risk of developing Parkinson’s disease than the rest of the population.”

The findings were published in the journal Federation of American Societies for Experimental Biology.

The researchers used stem cells from patients with Parkinson’s disease who had a mutation in the gene responsible for encoding the a-synuclein protein. At least 30 alterations in this gene have been associated with Parkinson’s, and a-synuclein protein clumps are a well-documented, albeit poorly understood, hallmark of the disease. The scientists also worked with normal embryonic cells that they modified using genetic editing to replicate the a-synuclein genetic mutation.

Prof. Ryan explains why using human cells makes this study particularly valuable. “Until now,” he says, “the link between pesticides and Parkinson’s disease was based primarily on animal studies as well as epidemiological research that demonstrated an increased risk among farmers and others exposed to agricultural chemicals.” “We are one of the first to investigate what is happening inside human cells,” he explained.

It was found that the neurons that had been exposed to the chemical had faulty mitochondria. Mitochondria, the “powerhouses of the cell,” are the organelles inside a cell that turn sugar, fats, and proteins in to the energy our body needs to survive and function.

Friday, June 1, 2018

Shoulder Subluxation

Shoulder subluxation refers to a partial dislocation of the shoulder joint. This occurs when the ball of the upper arm bone, called the humerus, partly comes out of the glenoid socket in the shoulder.

The shoulder is the most mobile joint in the body. It contains several bones, ligaments, and muscles that work together to keep it stable. Because the shoulder is so mobile, it is very susceptible to dislocation. Shoulder subluxation is often the result of trauma, injury or a stroke that weakens the arm muscles.

Symptoms of a shoulder subluxation can include a visibly deformed or out-of-place shoulder, pain, swelling, numbness or tingling or trouble moving the joint. A person may be able to feel the ball of the humerus moving in and out of the shoulder socket. They may also notice a clicking or catching sensation especially when reaching overhead.

Treatment aims to reposition the humerus back into the socket and ensure that it stays in place. Treatment options include: 1. Closed reduction involves a doctor attempting to gently maneuver the bone back into position. When this is achieved, severe pain should improve almost immediately. 2. Surgery may be recommended when dislocations recur or when nerves, blood vessels, or ligament in the shoulder have been damaged. 3. A splint, brace, or sling for a few days or weeks to prevent the shoulder from moving. The length of time will depend on the extent of the dislocation. 4. A muscle relaxant and an anti-inflammatory agent, such as ibuprofen, for pain and swelling. 5. Rehabilitation following surgery or time spent in a sling.

When a person seeks medical attention promptly and receives a correct diagnosis, shoulder subluxation is treatable. When no surgery is recommended, several months may pass before a person call tell how well the treatment is working.

Monday, May 28, 2018

Ulnar Tunnel Syndrome

Ulnar tunnel syndrome occurs when the ulnar nerve in the wrist becomes compressed by a cyst or repeated strain. The nerve compression can cause numbness or tingling in the hands or fingers, burning pain, muscle weakness in the hand, difficulty gripping with the fingers and thumb, and fingers bending into a claw shape.

The ulnar nerve runs from the neck down to the hand. At the wrist, the lunar nerve enters the hand though Guyon’s canal. If the nerve becomes compressed here, it causes ulnar tunnel syndrome. Compression of this nerve at the elbow is called cubital tunnel syndrome. Ulnar tunnel syndrome is less common than cubital tunnel syndrome and carpal tunnel syndrome.

Development of a ganglion cyst in the wrist is a common cause of ulnar tunnel syndrome but anything which places pressure on the ulnar nerve in the wrist can be a cause. The risk of developing ulnar tunnel syndrome is greater if a person has had a previous injury to the wrist, performs repetitive tasks with the hands, does activities or sports that put the wrist under strain or uses vibrating tools.

Diagnosis is typically made by medical history and physical exam. However, a physician may also suggest imaging studies (x-ray, CT scan, and/or MRI), electromyography, and/or nerve conduction study.

Monday, May 21, 2018

Acute Ischemic Stroke and High-Risk TIA

Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population.

A total of 4881 patients were enrolled at 269 international sites. The trial was halted after 84% of the anticipated number of patients had been enrolled because the data and safety monitoring board had determined that the combination of clopidogrel and aspirin was associated with both a lower risk of major ischemic events and a higher risk of major hemorrhage than aspirin alone at 90 days. Major ischemic events occurred in 121 of 2432 patients receiving clopidogrel plus aspirin and in 160 of 2449 patients receiving aspirin plus a placebo, with most events occurring during the first week after the initial event. Major hemorrhage occurred in 23 patients receiving clopidogrel plus aspirin and 10 patients receiving aspirin plus placebo.

In summary, patients with minor ischemic stroke or high-risk TIA, those who received a combination of clopidogrel and aspirin had a lower risk of major ischemic events but a higher risk of major hemorrhage at 90 days than those who received aspirin alone.

My Take:
The accompanying editorial points out that most of the benefit of this combination therapy is during the first week following a minor stroke or TIA. Limiting the use of both drugs to three weeks was recommended.

The use of aspirin as secondary prevention (after an ischemic event) is well established as a medical standard. However, the common practice of taking an aspirin daily as primary prevention is not. Several studies have demonstrated that the side effects of daily aspirin, including major hemorrhage and death, exceed any benefit in preventing an initial event. Again, the odds favor the use of aspirin after a patient has suffered a heart attack, stroke, or TIA.

The Bottom Line:
If you are taking an aspirin daily, even a low-dose or “baby” aspirin for primary prevention, please review this practice with your primary care physician. It is not the standard of care. If you have had a vascular event and are taking a daily aspirin with another blood thinner (combination therapy), like this study, please review this practice with your health care provider. Although still an accepted practice, the long term risks involved outweigh the benefits.

Source: May 16, 2018 New England Journal of Medicine

Friday, May 18, 2018

Do Nightshade Vegetables Make Arthritis Worse?

Nightshade foods contain solanine, a chemical which some people believe may aggravate arthritis pain and inflammation. The Arthritis Foundation say that his is not true. However, if a person feels that certain foods trigger their arthritis symptoms, including nightshades, they should avoid these foods.

Nightshade vegetables are part of the plant family Solanaceae. Some species are toxic, including the belladonna plant, which is also called deadly nightshade. Other species are commonly cultivated and eaten by humans. Common nightshade vegetables include white potatoes, tomatoes, eggplant, bell peppers, cayenne pepper and paprika.

Solanine is found in trace amounts in potatoes and is normally safe, though the leafy stalks of the potato plant and green potatoes are toxic, and solanine poisoning has been reported from eating green potatoes.

A person may be allergic to one or more nightshade vegetables if they experience the following symptoms shortly after eating them: hives or a skin rash, shortness of breath, wheezing, coughing, tightness of the throat, pale skin, and anaphylaxis.

Nightshade vegetables are excellent sources of nutrition, and no research to date has linked them specifically to increased inflammation or other symptoms of arthritis. A person should speak with a dietitian if they are concerned about the effects of a particular food on their health.

My Take:
Nightshades are the fifth most common food allergy I find clinically. Only wheat, dairy, soy and corn test positive more often. They are a weird group of foods because the common link is the presence of solanine not their appearance or use in the diet.

Wednesday, May 16, 2018

Wisdom Wednesday: Fibromyalgia vs Rheumatoid Arthritis

Fibromyalgia and rheumatoid arthritis share some symptoms, such as pain and exhaustion. If a person has both conditions, the symptoms may be difficult to distinguish. However, fibromyalgia and rheumatoid arthritis (RA) are unrelated and have different causes.

Fibromyalgia usually causes pain, stiffness, and tenderness in muscles and connective tissues throughout the body. RA tends to cause pain, swelling, and tenderness in certain joints. Other shared symptoms include pain mirrored on both sides of the body, stiffness that is worse in the morning, chronic exhaustion, reduced mobility and range of motion in muscles and joints, depression and anxiety.

While the effects may be similar, these conditions have different causes. Fibromyalgia changes the way the brain and nervous system process and interpret pain. People with the condition tend to feel amplified pain when they experience everyday injuries, such as strains.

RA is an autoimmune condition. It causes the immune system to harm the synovial tissues, which line the joints. This leads to inflammation and pain. Over time, RA can cause permanent damage to the bones and connective tissues in the joints. Inflammation may also spread to the lungs, skin, and eyes.

The medical community currently does not believe that fibromyalgia causes inflammation. However, recent research indicates that fibromyalgia may induce a type of inflammation that is not detected by routine blood tests. No evidence suggests that this inflammation causes joint or muscle damage like RA, and there may be no visible signs.

Though the conditions are unrelated, having RA may increase a person’s likelihood of developing fibromyalgia. An estimated 20-30% of people with RA also have fibromyalgia. Researchers suggest that the chronic inflammation and pain associated with RA may make the nervous system hypersensitive over time, leading to fibromyalgia.

Monday, May 14, 2018

Melatonin for Migraine Headache Prophylaxis

Interest in using melatonin for headache disorders has been developing for decades. Over the years, several clues have emerged to suggest that melatonin plays a role in a variety of headache disorders, including migraine, cluster, and tension. In patients with migraine headaches, for instance, some research shows that melatonin levels are lower on days when migraines occur. Patients with chronic migraine also appear to have lower melatonin levels than those with episodic migraine. Nighttime melatonin levels are also lower in patients with migraine compared with those without.

Imaging studies provide additional evidence for melatonin’s role in migraine prevention. During migraine attacks, the hypothalamus is activated. Given the presence of melatonin receptors within the suprachiasmatic nucleus of the hypothalamus, it is conceivable that melatonin’s binding and action in the hypothalamus could play a role in these headaches.

Melatonin might also affect headaches through direct effects on pain and inflammation. Animal studies show that melatonin can reduce pain perception in models of inflammation and neuropathic pain, possibly by binding receptors in the spinal cord or through a variety of other pathways.

Clinical research evaluating melatonin in patients with migraine headaches has focused on migraine prophylaxis. Most studies have found beneficial effects from melatonin on headache frequency; however, some of these studies also have serious methodologic limitations. Several uncontrolled studies found that taking melatonin over a period of 2-6 months significantly reduced migraine headache frequency in both adults and children. In these studies, about 62-78% of patients had a greater than 50% reduction in migraine frequency at the end of the trial compared with at the beginning.

In all clinical trials, melatonin was well tolerated, with sleepiness being the most commonly reported side effect. Less common side effects included fatigue, dizziness, constipation, stomach upset, and dry mouth. In the placebo-controlled trials, side effects were comparable to those of placebo and less common compared with either amitriptyline of sodium valproate.

Friday, May 11, 2018

A ‘Metabolic Switch’ May Explain Why Fasting Boosts Gut Health

Fasting for 24 hours can reverse the loss of stem cell function in the gut that accompanies aging, according to a study of mice.
Intestinal stem cells are crucial for tissue repair and regeneration, and their decline as we age means that it becomes harder to recover from gastrointestinal conditions and infections.

The researchers, who were led by a team from Massachusetts Institute of Technology (MIT) in Boston, discovered that fasting for 24 hours boosted regeneration of gut stem cells in younger and older mice. They found that fasting exerted this effect by means of a metabolic switch that causes cells to break down fatty acids instead of carbohydrates such as glucose. They also discovered a molecule that can activate the same switch – a finding that might lead to drugs that boost older people’s recovery from gastrointestinal infections or chemotherapy.

Stem cells are immature cells that have remarkable properties. For instance, they can replicate almost indefinitely and develop into virtually any type of cell in the body, forming an essential source of new cells for growth and repair in many tissues. In the gut, they maintain and repair tissue lining, which ‘renews itself’ about every 5 days.

Now published in the journal Cell Stem Cell, co-senior author Omer H. Yilmaz – an assistant professor of biology at MIT – explains that diet is known to have a “profound effect” on the ability of tissue to regenerate itself. There is also evidence that intermittent fasting can benefit health and age-related decline in tissue function.

Wednesday, May 9, 2018

Wisdom Wednesday: These Common Drugs May Raise Your Risk of Dementia

A landmark study has linked the long-term use of certain anticholinergic drugs to a higher risk of dementia later on. This investigation is believed to be the “largest and most detailed” study to date into long-term anticholinergic use and dementia risk.

Anticholinergics work by blocking a chemical messenger, or neurotransmitter, called acetylcholine that carries brain signals for controlling muscles. They are used to treat a variety of conditions, from Parkinson’s disease and loss of bladder control to asthma, chronic obstructive pulmonary disease, and depression.

Anticholinergics for depression, such as amitriphtyline, dosulepin, and paroxetine, have previously been liked to higher risk of dementia, even when they were used up to 20 years beforehand. Some studies have also suggested that use of any anticholinergic is linked to raised risk of dementia.

But the new study – which was led by the University of East Anglia (UES) in the United Kingdom and is now published in The BMJ – discovered that long-term use of only certain types of anticholinergics is linked to higher dementia risk. It confirms the link to long-term use of anticholinergics for depression, and for Parkinson’s disease and loss of bladder control. However, the study found no link between increased dementia risk and other anticholinergic drugs, such as antihistamines and medications for abdominal cramps.

For their investigation, the researchers used data from the Clinical Practice Research Database, which contains anonymized records for more than 11 million people across the U.K. The researchers used a system called the Anticholinergic Cognitive Burden (ACB) scale to score the anticholinergic effect of the drugs that the patients had been prescribed. An ACB score of 1 meant that a drug was “possibly anticholinergic,” whereas a score of 2 or 3 meant that it was “definitely anticholinergic.” Altogether, they analyzed more than 27 million prescriptions.

Monday, May 7, 2018

Melatonin for Migraine Headache Prophylaxis

Interest in using melatonin for headache disorders has been developing for decades. Over the years, several clues have emerged to suggest that melatonin plays a role in a variety of headache disorders, including migraine, cluster, and tension. In patients with migraine headaches, for instance, some research shows that melatonin levels are lower on days when migraines occur. Patients with chronic migraine also appear to have lower melatonin levels than those with episodic migraine. Nighttime melatonin levels are also lower in patients with migraine compared with those without.

Imaging studies provide additional evidence for melatonin’s role in migraine prevention. During migraine attacks, the hypothalamus is activated. Given the presence of melatonin receptors within the suprachiasmatic nucleus of the hypothalamus, it is conceivable that melatonin’s binding and action in the hypothalamus could play a role in these headaches.

Melatonin might also affect headaches through direct effects on pain and inflammation. Animal studies show that melatonin can reduce pain perception in models of inflammation and neuropathic pain, possibly by binding receptors in the spinal cord or through a variety of other pathways.

Clinical research evaluating melatonin in patients with migraine headaches has focused on migraine prophylaxis. Most studies have found beneficial effects from melatonin on headache frequency; however, some of these studies also have serious methodologic limitations. Several uncontrolled studies found that taking melatonin over a period of 2-6 months significantly reduced migraine headache frequency in both adults and children. In these studies, about 62-78% of patients had a greater than 50% reduction in migraine frequency at the end of the trial compared with at the beginning.

In all clinical trials, melatonin was well tolerated, with sleepiness being the most commonly reported side effect. Less common side effects included fatigue, dizziness, constipation, stomach upset, and dry mouth. In the placebo-controlled trials, side effects were comparable to those of placebo and less common compared with either amitriptyline of sodium valproate.

Friday, May 4, 2018

Sheep Disease Toxin Shines a Light on MS

In a recent study, those with multiple sclerosis were found to be more likely to harbor antibodies for a disease toxin normal found in sheep.

Multiple sclerosis (MS) affects an estimated 2.3 million people worldwide. MS affects the central nervous system (CNS) and can cause a range of symptoms – often involving problems with movement, sensation, balance, and vision.

Symptoms generally appear when an individual is in their 20s or 30s. Some can be managed, and, in some cases the progression of the disease can be slowed. However, there is still no cure. MS in an autoimmune disease, in which the immune system attacks otherwise healthy tissue – in this case, the CNS. Why the immune system should turn on itself is still not understood. Despite decades of work, the exact cause of the disease is still shrouded in mystery, though both genetic and environmental factors are thought to be involved.

Recently, a group of researchers at the University of Exeter in the United Kingdom looked for clues about MS’s origins in a surprising place: sheep.

The first clues that sheep might provide some insight into MS came in 2013, when a team in the U.S. noticed that some people with MS had increased levels of antibodies to a toxin known as epsilon toxin (ETX). This toxin is produce by the bacterium Clostridium perfingens, found in the guts of livestock – most commonly in sheep.

ETX crosses the gut wall and builds up in the kidneys and brain. And, once in the brain, it destroys both the myelin that coats nerves and the cells that produce myelin. In sheep, this type of ETX poisoning is called enterotoxaemia, or pulpy kidney disease.

In MS, myelin and the cells that produce it are destroyed by the immune system. This striking similarity between enterotoxaemia and MS makes any potential relationship worth investigating further.

Wednesday, May 2, 2018

Wisdom Wednesday: Dietary Intake and Age at Natural Menopause

Age at natural menopause is a matter of concern for women of reproductive age as both an early or late menopause may have implications for health outcomes.

Study participants were women aged 40-65 years who had experienced a natural menopause from the UK Women’s Cohort Study between baseline and the first follow-up. Natural menopause was defined as the permanent cessation of menstrual periods for at least 12 consecutive months. A food frequency questionnaire was used to estimate diet at baseline. Reproductive history of participants was also recorded. Regression modeling, adjusting for confounders, was used to assess associations between diet and age at natural menopause.

During the 4-year follow-up period, 914 women experienced a natural menopause. A high intake of oily fish and fresh legumes were associated with delayed onset of natural menopause by 3.3 years per portion/day and 0.9 years per portion/day respectively. Refined pasta and rice was associated with earlier menopause. A higher intake of vitamin B6 and zinc was also associated with later age at menopause. Stratification by age at baseline led to attenuated results.

Our results suggest that some food groups and specific nutrients are individually predictive of age at natural menopause.

My Take:
This is the abstract minus some of the statistical analysis. Several studies had shown an association between early onset of menopause and lower bone density, osteoporosis, depression and premature death. Other studies indicate an increased risk of cardiovascular and coronary diseases. However, late menopause has been associated with a higher risk for breast, ovarian and endometrial cancers.

Obviously, there are many other factors affecting the onset of menopause – genetic, environmental, hormonal and general health issues to list a few. But the link between diet is intriguing.

Monday, April 30, 2018

Congestive Heart Failure

Congestive heart failure is a progressive disease that gets worse over time, especially if it remains untreated. It is often caused by other conditions that weaken the heart, such as heart attack, coronary heart disease, high blood pressure and inflammation or damage to the heart muscle.

A 2016 study estimated that about half of people who develop heart failure live beyond 5 years after being diagnosed. However, there is no simple answer for life expectancy rates, as the average life expectancy for each stage of CHF varies greatly. CHF is not curable, but early detection and treatment may help improve a person’s life expectancy. Following a treatment plan that includes lifestyle changes may help improve their quality of life.

When a person has CHF, their heart has difficulty pumping blood to the other organs in the body. This problem occurs because the walls of the ventricles, which typically pump the blood through the body, become too weak, causing the blood [to] stay in the ventricle, rather than pushing it out. Blood remaining in the heart can cause fluid retention because the heart is not pumping enough blood through the body to push out excess fluids.

CHF has four stages based on the severity of symptoms. Common symptoms include swelling in the legs and feet caused by a buildup of excess fluid, bloating, shortness of breath, fatigue, nausea and chest pain.

Medical treatment for CHF involves reducing the amount of fluid in the body to ease some of the strain on the heart and improving the heart’s ability to pump blood. Doctors may prescribe angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to help the heart pump blood more effectively. In some cases, doctors may also prescribe beta-blockers to support these efforts and control the heart rate. Doctors also commonly prescribe diuretics for people with CHF, as they may help the body eliminate excess liquid.

Friday, April 27, 2018

Sugar Cereals Not Just for Breakfast Anymore… Millennials Eat Them as a Snack

Cereal companies are rebranding their cereals as snack foods and bringing back more sugar-laden products because that’s what consumers like. Are Froot Loops and Lucky Charms a breakfast food or a snack? Younger Americans increasingly see highly sweetened cereals as the latter. And the cereal industry has taken notice.

Sales of cold cereal have declined 17% since 2009 – not such sweet news for manufacturers, even though the cereal market remains a $9 billion a year business.

Mintel reported that 43% of people in the United States say they eat cereal as a snack. That includes 56% of millennials, compared with 33% of baby boomers. Research showing the increased popularity of “on-the-go” cereal packages reinforces the trend toward snacking.

Out of the best-selling cereals in the United States, Cheerios, Raisin Bran, and perhaps Frosted Mini Wheats check the “healthy” box in some significant way. Raisin Bran and Frosted Mini Wheats are high in fiber but have added sugar. Cheerios is made of whole grains and has only one gram of sugar per serving. Others – Honey Nut Cheerios, Frosted Flakes, Honey Bunches of Oats, Cinnamon Toast Crunch, Froot Loops, and Lucky Charms – are heavily sweetened.

My Take:
The article goes on and on, trying to convince us that all of these products have varying degrees of health benefits. With or without the added sugar, it’s all refined carbohydrates that promote metabolic syndrome, diabetes and heart disease.

Monday, April 23, 2018

Nanoparticles in Food Packaging May Disrupt Gut Function

Zinc oxide nanoparticles are added to many different types of food packaging. A new study finds that these minute particles might disrupt the way our intestines absorb nutrients.

Nanoparticles are between 1 and 100 nanometers in diameter. To put that into perspective, a human hair is around 75,000 nanometers across, and a red blood cell is roughly 7,000 nanometers across.

Nanoparticles have a relatively large surface area, which makes them more chemically reactive. This increased reactivity gives them unique properties that are utilized by the manufacturers of a vast range of products, including paints, cosmetics, windows, sunscreens, fabrics, and cars.

As nanoparticles are used ever more liberally, some scientists are becoming increasingly concerned about their potential impact on human health. It is very easy for nanoparticles to enter our bodies. They are small enough to pass through cell membranes, potentially disrupting their activity. However, little is known about how they might interfere with biological processes.

Looking to investigate these interactions, researchers from Binghamton University in New York looked at zinc oxide (ZnO) nanoparticles in food packaging in particular. ZnO nanoparticles are included in the packaging of certain food items, such as corn, chicken, tuna, and asparagus, because they have antimicrobial properties. Also, when sulfur-producing foods come in contact with a tin can, it produces a black discoloration; ZnO prevents this reaction, keeping the food fresh-looking.

First, using mass spectrometry, they assessed how much ZnO could realistically be transferred from the packaging into the food. The food was found to contain “100 times the daily dietary allowance of zinc.”

Friday, April 20, 2018

Time to Ditch ACE Inhibitors for CVD?

There is “little, if any, clinical reason” to use angiotensin-converting enzyme (ACE) inhibitors for the treatment of hypertension or other cardiovascular indications because angiotensin receptor blockers (ARBs) are just as effective with fewer side effects, a new review concludes.

The review, published in the Journal of the American College of Cardiology on April 3, was led by Franz Messerli, MD, University Hospital, Bern Switzerland.

Messerli and colleagues reviewed data from 119 randomized clinical trials of ACE inhibitors and ARBs in more than half a million patients and found no difference in efficacy between the two drug classes with regard to the surrogate endpoint of blood pressure and the outcomes of all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. But ACE inhibitors have a higher incidence of adverse reaction – namely cough and very low risks of angioedema and fatalities – that are more prevalent in dark-skinned people, they write.

Despite this, most guidelines for the management of patients with cardiovascular disease recommend ACE inhibitors as first-choice therapy, whereas ARBs are merely considered an alternative for ACE inhibitor-intolerant patients, Messerli and colleagues point out.

My Take:
The rest of the article is rebuttal from various cardiologists on the pros and cons of using ARBs in lieu of ACE. The best quote – “And the side effect of angioedema, although rare, can be fatal, and if ACE inhibitors are proposed as part of the polypill then millions will be exposed and fatalities will occur.”

Wednesday, April 18, 2018

Wisdom Wednesday: Blood Test Detects Alzheimer’s Before Symptoms Appear

One of the major issues that hamper Alzheimer’s research is that the disease is always caught at a relatively late stage. This is because symptoms develop slowly over several years; they become obvious long after the condition has made changes in the brain.

The only reliable methods of diagnosis are positron emission tomography (PET) scan and cerebrospinal fluid (CSF) analysis collected by lumbar puncture.

One of the hallmarks of Alzheimer’s disease is an abnormal buildup of amyloid-beta plaques in the brain. Amyloid-beta is present in the healthy brain, but, in individuals with Alzheimer’s the protein is folded incorrectly and accumulates. Amyloid-beta plaque clusters can begin developing 15-20 years before symptoms of Alzheimer’s appear.

This unhealthy protein is the basis of a new blood test. In a study published in the journal EMBO Molecular Medicine, researchers led by Klaus Gerwert, describe their groundbreaking work.

The new blood test uses immune-infrared sensor technology. Based on an antibody, the sensor extracts all amyloid-beta from the blood sample. The two versions of amyloid-beta absorb infrared light at different frequencies allowing he researchers to measure the relative levels of healthy and unhealthy protein.

In the initial phase of the study individuals who showed subtle, early symptoms of Alzheimer’s, the test detected changes in levels of amyloid-beta that correlated with abnormal deposits visualized using brain scans.

In the next phase, they assessed blood samples from 65 individuals who later went on to develop Alzheimer’s and compared them with 809 individuals who did not develop the disease. On average, the blood test could detect Alzheimer’s in individuals 8 years before clinical symptoms became apparent.

Monday, April 16, 2018

The Bittersweet Truth

Taste receptor cells are not confined to the oral cavity. The gut and pancreas are inundated with taste receptor cells. Taste cells in the gut and pancreas do not convey the sensation of taste to the brain. Instead, they are responsible for sensing nutrients and maintaining the balance of hormones essential in metabolic processes. Activation of these receptors by their respective sweet or bitter substances triggers the release of hormones that regulate appetite and satiety and help maintain appropriate glucose levels in the blood stream. This observation has drawn a plausible link between dysfunction of taste receptor cells and the emergence of diseases such as obesity and diabetes.

Sweet taste receptors in the enteroendocrine cells (cells that secrete hormones) of the gut and pancreas are suggested to play an important role in nutrient sensing and sugar absorption, both processes necessary for energy and maintaining a normal metabolism. When sweet taste receptors sense sugars, they elicit the release of gut hormones. One such hormone, glucagon-like peptide 1 (GLP-1), is responsible for facilitating the absorption of glucose into the bloodstream, enhancing insulin secretion in the pancreas and regulating appetite. Disruptions in any of these physiological processes can result in the development of type II diabetes. In a study aiming at quantifying the levels of sweet taste receptors in the upper gut of healthy and diabetic individuals, researchers observed that the levels of sweet taste receptors were diminished in diabetic type II subjects with elevated blood glucose concentrations. This observation was consistent with previous results showing that type II diabetes patients secreted low levels of GLP-1 in response to a meal in comparison to healthy individuals.

Sweet taste receptors in the gut and pancreas also “taste” artificial sweeteners, also known as non-nutritive sweeteners (NNS). Several research groups found that exposure of mouse cells to sucralose, the sweetener in Splenda, caused the release of GLP-1.

Friday, April 13, 2018

Alzheimer’s: Scientists find the cause of evening agitation

A new study has uncovered a biological clock circuit that may explain why people with Alzheimer’s disease or other forms of dementia can become more agitated or aggressive in the early evening.

Sundowning is a condition that is typically seen in people with Alzheimer’s, when behavior becomes restless, agitated, and aggressive, accompanied by confusion. Its name is derived from the fact that it usually begins or gets worse in the late afternoon or early evening.

Biological clocks are specific groups of proteins that communicate with cells in nearly every organ and most tissue in the body. They respond to changes in light and dark in the environment and give rise to the circadian rhythms – that is physical, behavioral, and mental changes that “follow a daily cycle.”

Scientists have discovered that the genes that make and control the various components of biological clocks are largely similar in humans, mice, fruit flies, fungi and many other organisms. While biological clocks are found nearly everywhere in the body, they are all synchronized by a “master clock’ in the brain.

In humans, mice, and other vertebrates, the master clock is located in the suprachiasmatic nucleus, which is a cluster of neurons inside the hypothalamus region of the brain. The cluster contains around 20,000 cells and receives signals directly from the eyes.

For their study, Prof. Saper and his colleagues measured the frequency and intensity of interactions between male mice as “resident mice” defended their territory against “intruder mice” that were introduced into their cages at different times of the day. “The mice,” explains Prof. Saper, “were more likely to be aggressive in the early evening around lights out, and least aggressive in the early morning, around lights on.” “It looks like aggressiveness,” he continues, “build up in mice during the lights on period, and reaches a peak around the end of the light period.”

In another set of experiments, the researchers manipulated the mice’s master biological clock by tweaking genes in the neurons that regulate it. They found that when they stopped the master clock neurons from being able to make a specific chemical messenger, or neurotransmitter, the mice lost their circadian pattern of aggression. Aggressiveness remained high all the time, showing no highs and lows.

Wednesday, April 11, 2018

Wisdom Wednesday: Oral Vitamin B12 Versus Intramuscular Vitamin B12

Vitamin B12 deficiency is common, and the incidence increases with age. Most people with vitamin B12 deficiency are treated in primary care with intramuscular (IM) vitamin B12. Doctors may not be prescribing oral vitamin B12 formulations because they may be unaware of this option or have concerns regarding its effectiveness.

The goal of the review was to assess the effects of oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency.

The primary outcomes of data collection and analysis were serum vitamin B12 levels, clinical signs and symptoms of vitamin B12 deficiency, and adverse events. Secondary outcomes were health-related quality of life, acceptability to patients, hemoglobin and mean corpuscular volume, total homocysteine and serum methylmaloic acid levels.

Only three RCTs met our inclusion criteria. The trials randomized 153 participants (74 participants to oral vitamin B12 and 79 participants to IM vitamin B12). Treatment duration and follow-up ranged between three and four months. The mean age of participants ranged from 38.6 to 72 years. The treatment frequency and daily dose of vitamin B12 in the oral and IM groups varied among trials. The overall quality of evidence for this outcome was low due to serious imprecision (low number of trials and participants). In two trials employing 1000 ug/day oral vitamin B12, there was no clinically relevant difference in vitamin B12 levels when compared with IM vitamin B12. Orally taken vitamin B12 showed lower treatment associated costs than IM vitamin B12.

Low quality evidence shows oral and IM vitamin B12 having similar effects in terms of normalizing serum vitamin B12 levels. Further trials should conduct better randomization and blinding procedures, recruit more participants, and provide adequate reporting.

Monday, April 9, 2018

Clinically Useless

Patients with uncomplicated cellulitis frequently undergo blood culture and imaging, despite recommendations against routine use of such testing, finds a retrospective study in JAMA Internal Medicine. And the economic toll is significant.

Researchers examined the medical records of 183 patients seen at one emergency department with presumed uncomplicated cellulitis who were subsequently admitted. One third had blood cultures (with growth detected in 1 patient), but culture was deemed appropriate according to clinical guidelines in just 10% of the overall cohort. Additionally, nearly 70% underwent imaging (e.g., ultrasound, radiograph), and none of these tests were considered appropriate.

The researchers estimate that the national cost of “these largely clinically useless diagnostic studies” exceeds $225 million annually. They note that guidelines from the Infection Diseases Society of American recommend against imaging unless patients also have febrile neutropenia, and against culture unless patients are severely immunocompromised, show systemic toxic effects, or have had an animal bite.

My Take:
This is why we have the most expensive health care system in the world that ranks among the worst of all industrialized nations. The “standard of care” seemingly is only applied by physicians when it suits their purpose. Unfortunately, too often the goal is money.

Friday, April 6, 2018

Gut Microbiota Influencing Obesity

Polyphenols may generate numerous health benefits by modulating the gut microbiota (GM). Phytochemicals that can influence GM have recently been studied as adjuvants to support healthy weight and inflammatory response. These phytochemicals include polyphenols and their derivatives, carotenoids, and thiosulfates, which were “further sub-classified into four main groups: flavonoids (including eight subgroups), phenolic acids (such as curcumin), stilbenoids (such as resveratrol), and lignans.”

“An imbalance of GM, or dysbiosis, can be the cause of, or at least lead to the progression of several pathologies such as infectious diseases, gastrointestinal cancers, cardiovascular disease, inflammatory bowel disease, and even obesity and diabetes.” Of the phytochemicals ingested, 90-95% “reach the colon in high concentrations, where they are degraded by the microbial enzymes prior to absorption.

Joining the ranks of prebiotics and probiotics, polyphenols are now attracting interest in the media and the research community as potential therapeutic agents in supporting health weight management. Proposed mechanisms of actions include “inhibition of the differentiation of adipocytes, increased fatty acid oxidation, decreased fatty acid synthesis, increased thermogenesis, the facilitation of energy metabolism and weight management, and the inhibition of digestive enzymes.

As promising as this is, more research is required to determine [the] role of micronutrients and phytochemicals as therapeutic agents in modulating the GM, and, therefore, influencing weight management and the inflammatory response.

My Take:
If you read the current (and all past editions) Guyton’s Physiology it states that the “role of the colon is to reabsorb water to create a formed stool.” We now understand that colon has many roles, the least of which is to create a formed stool.

Wednesday, April 4, 2018

Wisdom Wednesday: Vitamin D Linked to Metabolic Syndrome in Postmenopausal Women

Postmenopausal women with vitamin D deficiency have greater risk for metabolic syndrome than those with sufficient levels, data from a cross-sectional cohort study suggest. Levels of 25-hydroxyvitamin-D below 20 ng/mL were also linked to a greater likelihood of high triglycerides and low high-density lipoprotein (HDL) cholesterol.

“These results suggest that the maintenance of adequate serum levels of 25(OH)D in postmenopausal women may reduce the risk of developing [metabolic syndrome], a condition that is known to be related to cardiovascular events and mortality in this group,” write Eneida Boteon Schmitt, MD, from Sao Paulo State University’s Botucatu Medical School in Brazil, and colleagues.

The study, published in the January 2018 issue of Maturitas, included 463 women, 45 to 75 years old, who had not menstruated for at least a year, were not taking vitamin D supplements, and had a diagnosis of cardiovascular disease. The researchers measured their total cholesterol, HDL levels, low-density lipoprotein (LDL) levels, triglycerides, glucose, insulin, and 25(OH)D levels.

Vitamin D deficiency was defined as serum 25(OH)D levels below 20ng/mL, whereas levels between 20 and 29 ng/mL were insufficient. Levels of at least 30 ng/mL were considered sufficient. Diagnosis of metabolic syndrome required presence of at least three of five criteria: a waist circumference greater that 88 cm, triglycerides at least 150mg/dL, HDL levels below 50 mg/dL, blood pressure at least 130/85, and glucose at least 100 mg/dL.

Just under a third (32.0%) of the women had sufficient vitamin D levels, and a similar proportion (32.6%) had insufficient levels. The remaining 35.4% were deficient. More than half (57.8%) of the women without sufficient vitamin D (below 30 ng/mL) had metabolic syndrome compared with 39.8% of the women with sufficient vitamin D levels.

Monday, April 2, 2018

Can Beets Tackle Alzheimer’s at Its Root?

Alzheimer’s disease is characterized by beta-amyloid plaques in the brain that disrupt the normal functioning of neurons. Could a common vegetal pigment provide the fix?

Researchers from the University of South Florida in Tampa have experimented with a compound called betanin, which is the pigment that give beets their dark red color. Li-Lune Ming, Darrell Cole Cerrato, and their colleagues explain that this vegetal pigment interacts with amyloid beta, preventing some of the processes that may have harmful effects on the brain. The results of the team’s research were presented this week at the 255th National Meeting & Exposition of the American Chemical Society, held in New Orleans, LA.

A study published last year in The Journals of Gerontology Series A showed that drinking beetroot juice before aerobic exercise made the aging brain look younger by increasing blood flow to the brain and regulating the circulation of oxygen.

Intrigued by this and similar research, Ming and team decided to see whether betanin, commonly found in these root vegetables, could be used to prevent amyloid beta from forming into clusters that impacted communication between brain cells.

Studies show that the aggregation of amyloid beta into harmful clusters is often dependent on their interaction with metal molecules – especially those of zinc and copper – in the brain. When such clusters do form, the researchers of the new study explain, amyloid beta facilitates brain inflammation and the oxidation of neurons, which results in irreparable damage to these brain cells.

They conducted a series of laboratory experiments in which they monitored the activity of amyloid beta in different contexts using 3, 5-Di-tert-butylcatechol (DTBC), a compound that allows researchers to observe the process of oxidation. By employing ultraviolet-visible spectrophotometry, the researchers saw that amyloid beta on its own did not produce much oxidative damage – but when it bound to copper molecules, the oxidation was considerable.

Friday, March 30, 2018

Folate Deficiency Associated with Gene Modulation

Folate deficiency has been associated with the onset of varied metabolic abnormalities, “including insulin resistance, by altering epigenetic processes on key regulatory genes,” such as the calcium/calmodulin-dependent protein kinase kinase 2 (CAMKK2). CAMKK2 is part of the calcium-triggered signaling cascade, and influences obesity and glucose metabolism.

This study looked at subjects with a total folate intake lower than 300 ug/d, more “fat mass (especially trunk fat), as well as statistically higher levels of glucose, insulin, homeostatic model assessment-insulin resistance (HOMA-IR) index, cortisol, and plasminogen activator inhibitor-1, and compared [these levels] to those consuming greater than 300 ug/d [of folate].” They determined that “folate deficiency was related to lower CAMKK2 methylation.

In conclusion, this summary proposed “associations between low folate intakes, lower CAMKK2 gene methylation, and insulin resistance in obese individuals.”

My Take:
I know this reads as pretty technical, but it is the “dummied down” version. So, let me define some terms for you.

Epigenetics is the study of gene expression rather than gene composition. The term literally translates as “above genetics.”

Folate is the food form of folic acid, one of the B vitamins involved in hundreds of metabolic pathways in the human body. However, folate cannot be used by the body in its’ food form. It must have a ‘methyl’ group attached to it through a process called methylation.

I have written frequently about variations in genetic snippets that impair methylation of folate. However, this study shows impaired gene expression from a dietary deficiency of folate that contributes to metabolic syndrome.

Folate, translated as ‘foliage’ is found in all dark green leafy vegetables. Most Americans are deficient in their daily intake because they just don’t eat any vegetables. I recommend five servings of veggies daily and count a big salad as two servings.

The Bottom Line:
This study illuminates some of the biochemistry, including genetic expression, that links poor dietary habits to diabetes and heart disease. While supplementation of bioavailable folic acid is a common occurrence in my practice, it does not replace a healthy diet.

Source: Nutrition Research, February 2018

Wednesday, March 28, 2018

Wisdom Wednesday: Essential Oils May Disrupt Normal Hormonal Activity

New research suggests that the chemicals contained in essential oils such as lavender oil and tea tree oil may disrupt the normal functioning of hormones, leading to a condition called male gynecomastia in prepubescent boys.

Male gynecomastia is a condition in which boys develop noticeable breasts as a result of having abnormally high levels of estrogen, the female sex hormone. Research has previously linked the condition to essential oils such as lavender and tea tree oil. Such oils are regularly used in personal hygiene and cosmetic products, as well as in laundry detergents and aromatherapy candles and devices.

A study from 2007 found that the gynecomastia coincided with the use of essential oil-based products, and that the symptoms disappeared with the products were discontinued. The same study also found that lavender and tea tree oil had estrogen-boosting and anti-androgenic effects on human cells.

The new study was presented at the annual meeting of the Endocrine Society tested the impact of eight components that are commonly found in tea tree and lavender oil on human cancer cells to study their effect on hormonal activity.

Essential oils contain hundreds of chemicals. Researchers picked out 4-terpineol, dipentene/limonene, alpha-terpineol, linalyl acetate, linalool, alpha-terpinene, and gamma-terpinene for study. The first four components are common to both tea tree oil and lavender oil. The research revealed that all of the chemicals tested had an endocrine-disrupting activity to a certain extent.

Monday, March 26, 2018

Low-Calorie Sweeteners May Promote Metabolic Syndrome

New data presented at the annual meeting of the Endocrine Society, held in Chicago, suggests that consuming low-calorie sweeteners could put people at risk of metabolic syndrome.

Around 34% of adults in the United States have metabolic syndrome, the umbrella term for: high blood pressure; high blood sugar; high cholesterol levels; and abdominal fat.
We know that metabolic syndrome doubles the risk of heart disease and disease of the blood vessels, putting individuals at risk of heart disease and stroke. People with metabolic syndrome are also 3 to 5 times more likely to develop type 2 diabetes.

In this new study, researchers from George Washington University examined the effects of a low-calorie sweetener called sucralose on human stem cells from fat tissue. These were experimented on in petri dishes that simulated an obesity-promoting environment.

The scientists mimicked the typical concentration of sucralose in the blood of people who consume high quantities of low-calorie sweeteners. When this was administered to the stem cells, the team noticed increased expression of genes linked with fat production and inflammation.
The authors followed this up with a separate experiment involving biopsy samples of abdominal fat from people who were regular consumers of low-calorie sweeteners. In fat samples from people that were a healthy weight, they did not find a significant increase in gene expression, but in the fat samples from overweight or obese participants, there was significant overexpression of fat-producing and inflammation-inducing genes.

Study co-author Sabyasachi Sen, who is an associate professor of medicine at George Washington University, describes the results. “Our stem cell-based studies indicate that low-calorie sweeteners promote additional fat accumulation within the cells compared with cells not exposed to these substances, in a dose-dependent fashion – meaning that as the dose of sucralose in increased more cells showed increased fat droplet accumulation.”

Friday, March 23, 2018

Who is Shaping the Food Choices of the Future?

A conference was held by the British Nutrition Foundation (BNF) in October 2017 to explore future trends in agriculture, manufacturing and retailing, and the relationship between these trends and food choice. I picked a few of the presented topics for your review.
Professor Judith Buttriss, Director General of the BNF, described the grand challenge of securing a sustainable food supply for the world’s growing and more prosperous population in the face of climate change, which will increasingly affect what can be grown and where; the likelihood of the need for trade-offs in relation to the food supply and ecosystem; and public health trend and the associated need to encourage consumer behavior change.

Professor Robert Edwards, Head of the School of Agriculture, Food and Rural Development at Newcastle University, presented a case study on innovation in crop protection. He described how for the last 60 years farming has been heavily dependent on the use of pesticides and herbicides to protect crops. Currently 40% of the global food supply is dependent on agrochemical intervention. Professor Edwards described promising solutions such as new crop breeding technologies and biological treatments, which promote plant vigor and innate defense and precision agriculture technologies.

James Walton, Chief Economist at Institute of Grocery Distribution, discussed results from recent market research that explored the current state of shopper thinking about healthy eating. Currently, 89% of consumers report taking personal responsibility for their diet, with most reporting that they are doing something to make an improvement, such as reducing alcohol or meat intake. The most popular dietary goal was to eat more fruit and vegetables. Mr. Walton ended by describing how online grocery shopping is becoming more popular and can aid healthier choices.

Judith Batchelar OBE, highlighted that legislation, food scares and influential chefs have all shaped consumer food choice over the years and explained how supermarkets have a huge opportunity, to educate and influence consumers about healthy eating.

Wednesday, March 21, 2018

Wisdom Wednesday: Holistic Properties of Foods: A Changing Paradigm in Human Nutrition

Traditionally, the study of nutrition has been based on a reductionist approach, reducing a food down to constituent nutrients and then investigating the effects of these nutrients, either singly or together, on metabolism and metabolic outcomes. However, nutrients per se are not consumed by a person, but rather are consumed in the form of foods. Because of this the complex food matrix itself influences nutritional outcomes, which can often not be fully explained on the basis of the effects of “the sum of the nutrients” alone. Nutrient additivity effects, nutrient interactions, effects of food components other than the classical nutrients, effects of the food matrix for both single foods and combinations of foods consumed as meals on the kinetics of nutrient digestion and subsequent metabolism and metabolic outcomes are discussed. It is concluded that a paradigm shift in human nutrition is needed, with more consideration being given to the holistic effects of specific foods and mixtures of foods constitutes meals and diets.

My Take:
Unfortunately, only the abstract is currently available as it is a current publication. However, that gives me a little more space to play.

This holistic concept is not new to nutrition, looking at the whole food was all we understood for thousands of years. It wasn’t until the invention of the microscope in the 1600s and subsequent development of biochemistry as a scientific discipline two centuries later that led to this reductionist view of life.

By the 1920’s, a dentist named Dr. Royal Lee was decrying the decline of our food quality. He purchased land in Wisconsin and began growing crops to produce a food supplement. In 1929, he produced and marketed ‘Catalyn’, a whole food supplement comprised of local grown crops. His ingredients were alfalfa, barley grass, beets, Brussels sprouts, buckwheat, kale, kidney beans oats, pea vine and Spanish black radish.

Monday, March 19, 2018

Have Scientists Found an Answer to Chronic Pain?

Using computer modeling, researchers have designed a new compound that may help to treat neuropathic pain. In animal trials, it produced immediate, long-lasting therapeutic effects.

Neuropathic pain is a chronic condition wherein people have a heightened sensibility to pain, or hyperalgesia, and feel pain following stimuli that would not usually cause pain, or allodynia. For some individuals, the pain can come and go, seemingly at random. For others, however, it can be continuous. The condition affects up to 10% of the population of the United States, and there are currently no specific treatments that significantly relieve the discomfort and pain.

As it stands, anti-depressants and anti-epileptics are most commonly used to treat neuropathic pain, but less than 50% of people report a significant reduction to their pain. There is a range of conditions and situations that could lead to neuropathic pain. These include diabetes, spinal cord injury, herpes zoster infection, toxins, trauma, and chemotherapy. But although certain risk factors are known, there are still many gaps in our knowledge.

It is thought that peripheral neuropathic pain is caused by lesions in nerves. These lesions disrupt the blood-nerve barrier, allowing blood and the immune cells that it carries to contact the nerves. However, exactly how and why this produces neuropathic pain is not understood. The molecular interactions and chemical pathways involved are still being investigated.

Researchers from the Institute for Neurosciences of Montpellier found that immune cells, which flood the damaged nerves at the site of the lesion, produce a cytokine called FL which binds to activate FLT3 receptors. FLT3 receptors are produced by hematopoietic stem cells, the cell type that gives rise to blood cells.

Once the two molecules lock together, a chain reaction is activated that impacts the sensory system, producing pain and allowing it to persist. This is known as chronification. The findings are published this week in the journal Nature Communications.

Once the team understood the role of FLT3 in generating neuropathic pain, they analyzed 3 million potential molecular configurations eventually finding an anti-FTL3 molecule – which they dubbed BDT001.

Friday, March 16, 2018

Antimicrobial Stewardship

The first antimicrobial stewardship programs were introduced in hospitals more than 30 years ago to address inappropriate antibiotic prescribing and increasing antibiotic resistance. Since then a large body of evidence on the effectiveness and safety of this approach has accumulated.

The purpose of antimicrobial stewardship is to promote the prudent use of antibiotics in order to optimize patient outcomes, while at the same time minimizing the probability of adverse effects, including toxicity and the selection of pathogenic organisms, and the emergence and spread of antibiotic resistance.

The previous Cochrane Review demonstrated that interventions to reduce excessive antibiotic prescribing were successful, with persuasive and restrictive interventions being equally effective in reducing prescribing after six months. The recent update demonstrates that enabling and restrictive interventions are associated with a 15% increase in compliance with desired practice, a 1.95-day decrease in duration of antibiotic treatment, and a 1.12-day decrease in inpatient length of stay, without compromising patient safety.

Initiatives for implementing or strengthening antimicrobial stewardship were primarily developed as a response to increasing antibiotic resistance. Increasing antibiotic use results in increasing antibiotic resistance rates. But does improving antibiotic prescribing reverse antibiotic resistance rates? The updated Cochrane Review does not provide an answer; only 9% of the randomized controlled trials and 19% of the interrupted time series studies reported microbial outcome data. However, a reduction in the rate of Clostridium difficile infections was consistently demonstrated in the studies interventions.

Despite the extensive evidence base, antimicrobial stewardship programs are not a requirement in all hospitals. Antimicrobial resistance requires global action. This requires political commitment and resources, suggesting a role for continued advocacy by public health and specialist professionals and organizations. One significant characteristic of the evidence base is that 183 or the 221 studies in the updated Cochrane Review were performed in Europe or North American.

Wednesday, March 14, 2018

Wisdom Wednesday: U.S. Cancer Treatment Guidelines ‘Often Based on Weak Evidence’

Cancer treatment guidelines produced by the US National Comprehensive Cancer Network (NCCN) are often based on low quality evidence or no evidence at all, finds a study published by The BMJ today.

The researchers, led by Dr. Vinay Prasad at Oregon Health & Science University, say their findings “raise concern that the NCCN justifies the coverage of costly, toxic cancer drugs based on weak evidence.”

These recommendations are used by US private health insurers and social insurance schemes to make coverage decisions, and guide global cancer practice, but it is not clear how the evidence is gathered or reviewed.

In the US, the Food and Drug Administration (FDA) approves all new drugs and grants new indications for drugs already on the market. The NCCN makes recommendations both within and outside of FDA approvals, but patterns of NCCN recommendations beyond FDA approvals have not been analyzed.

So Dr. Prasad and his team compared FDA approvals of cancer drugs with NCCN recommendation in March 2016 for a contemporary sample of drugs. When the NCCN made recommendations beyond the FDA’s approvals, the evidence used to support those recommendations was evaluated.

A total of 47 new cancer drugs were approved by the FDA for 69 indications over the study period, whereas the NCCN recommended these drugs for 113 indications, of which 69 (62%) overlapped with the 69 FDA approved indications and 44 (39%) were additional recommendations.
Only 10 (23%) of these additional recommendations were based on evidence from randomized controlled trials, and seven (16%) were based on evidence from phase III studies. Most relied on small, uncontrolled studies or case reports, or no offered evidence.

And almost two years after their analysis, the researchers found than only six (14%) of the additional recommendations by the NCCN had received FDA approval.

Monday, March 12, 2018

Type 2 Diabetes: New Guidelines Lower Blood Sugar Control Levels

The American College of Physicians have now published their new guidelines regarding the desired blood sugar control levels for people with type 2 diabetes. The recommendations aim to change current therapeutic practices, and doctors should aim for a moderate level of blood sugar when treating their patients.

According to the most recent estimates, almost 30 million people in the United States have type 2 diabetes, which amounts to over 9% of the entire U.S. population.

Once diagnosed with type 2 diabetes, patients are often advised to take what is known as a glycated hemoglobin (HbA1c) test in order to keep blood sugar levels under control. The test averages a person’s blood sugar levels over the past 2 or 3 months, with an HbA1c score of 6.5% indicating diabetes.

But some studies have pointed out that the HbA1c test may currently be overused in the U.S., and they have suggested that such over-testing may lead to over-treating patients with hypoglycemic drugs. These drugs often have a range of side effects, such as gastrointestinal problems, excessively low blood sugar, weight gain, and even congestive heart failure. Additionally, as some researchers have pointed out, “Excessive testing contributes to the growing problem of waste in healthcare and increased patient burden in diabetes management.”

The existing recommendations of a score of 6.5% - or below 7% - decrease the risk of microvascular complications over time. However, the American College of Physicians (ACP) found that the evidence for such a reduction is “inconsistent.”

Friday, March 9, 2018

Could Vitamin D Lower Cardiovascular Death Risk?

People who have cardiovascular disease can reduce their risk of death by almost a third simply by maintaining normal vitamin D levels. This is the finding of a new study recently published in The Journal of Clinical Endocrinology & Metabolism.

Cardiovascular disease (CVD) is the number 1 killer in the United States. Heart disease alone is responsible for around 610,000 deaths in the country every year. Previous research suggests that vitamin D status may play an important role in cardiovascular health. A study in 2016, for example, associated low vitamin D levels with greater risk of stroke, heart failure, heart attack, and cardiovascular death.

The new study – led by Prof. Jutta Dierkes, of the Department of Clinical Medicine at the University of Bergen in Norway – further investigated the role that vitamin D levels play in the risk of death from CVD.

Prof. Dierkes and colleagues analyzed the blood samples of 4,114 adults who had suspected angina pectoris, which is chest pain as a result of coronary heart disease. Subjects were an average age of 62 at study baseline, and they were followed-up for an average of 12 years.

The team assessed the subjects’ blood samples for levels of 25-hydroxyvitamin D, or 25(OH)D, which is the primary circulating form of vitamin D. During follow-up, there were a total of 895 deaths. Of these, 407 were related to CVD.

According the National Institutes of Health (NIH), as 25(OH)D level of 50-125 nanomoles per liter (nmol/l) is “generally considered adequate for bone and overall health in healthy individuals.”

Wednesday, March 7, 2018

Wisdom Wednesday: A Short History of Quinine

As a follow-up to Monday’s blog, I thought you might enjoy some history about quinine. Legend has it that the bark of the fever tree was first used by the Spanish in the early 1630s when it was given to the Countess of Chinchon, who had contracted malaria (know colloquially as the ‘fever’) while living in Peru. The Countess recovered and the healing properties of the fever tree were passed to Europe.
It was imported to Europe under the name ‘Jesuits Powder’ which proved a very poor selling strategy in Protestant England. Even when Charles II in 1679 was cured of the ‘fever’ its popularity was not assured as its use remained the secret of his physician (Robert Talbor).

However, the healing power of this remarkable tree only became world renowned in the 1820’s when officers of the British Army in India, in an attempt to ward off malaria, mixed quinine (the extract from the bark of the fever tree) with sugar and water, creating the first Indian Tonic Water.

It was made more palatable when they added a little expedient of gin to the mixture. The original gin and tonic was thus born, and soon became the archetypal drink of the British Empire, the origins of which were firmly planted in the fever tree.
Medical historians claim that the British lost India primarily because the British forces were too drunk from the daily ritual of drinking gin and tonic to effectively fight.

Colonialism produced a huge demand for the bark of the fever tree. In the 1850s the East India Company alone spend 100,000 pounds annually on the bark, but it still brought in nowhere nearly enough to keep the colonists healthy. The answer was to try and cultivate fever trees in the colonies. This initiative inspired intrepid plant hunters across Europe to risk all and travel to South America to harvest these most valuable seeds. The Englishman, Richard Spruce, brought back seeds from Ecuador, which were subsequently grown in India and Ceylon, but they turned out to be of a species that was relatively poor in quinine. Using the wrong species of herb or wrong part of the plant remains a significant issue in herbology today with up to 80% of commercial products being ineffective as a result of this practice.

Monday, March 5, 2018

Quinine for Muscle Cramps

Muscle cramps can occur anywhere and for many reasons. Quinine has been used to treat cramps of all causes. However, controversy continues about its efficacy and safety. This review was first published in 2010 and searches were updated in 2014.

Three review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We contacted study authors for additional information. We identified 23 trials with a total of 1586 participants. Fifty-eight percent of these participants were from five unpublished studies. Quinine was compared to placebo (20 trials), vitamin E (4 trials), a quinine-vitamin E combination (3 trials). The most commonly used quinine dosage was 300 mg/day (range 200 to 500 mg).

The risk of bias in the trials varied considerably. All 23 trials claimed to be randomized, but only a minority described randomization and allocation concealment adequately.

Compared to placebo, quinine significantly reduced cramp number over two weeks by 28%, cramp intensity by 10%, and cramp days by 20%. Cramp duration was not significantly affected.

A significantly greater number of people suffered minor adverse events on quinine than placebo, mainly gastrointestinal symptoms. Overdoses of quinine have been reported elsewhere to cause potentially fatal adverse effects, but in the included trials there was no significant difference in major adverse events compared with placebo.

There is low quality evidence that quinine (200 mg to 400 mg daily) significantly reduces cramp number and cramp days and moderate quality evidence that quinine reduces cramp intensity. There is moderate quality evidence that with use up to 60 days, the incidence of serious adverse events is not significantly greater than for placebo in the identified trials, but because serious adverse events can be rarely fatal, in some countries prescription of quinine is severely restricted.

Friday, March 2, 2018

How Fasting Boots Exercise’s Effects on Endurance

Intermittent fasting, such as eating only on alternate days, might enhance the ability of aerobic exercise to increase endurance because the body switches to using fats and ketones as a source of fuel for muscles instead of carbohydrates.

This was the conclusion that researchers came to after studying the effect in mice with such a regimen for a limited period of time. Their study is to be published in the FASEB Journal.

The findings suggest that three meals per day and snacking may not be the only eating habit for people who engage in endurance sports to reach peak performance and maintain good health.

“Emerging evidence,” explains senior study author Dr. Mark Mattson, from the Laboratory of Neurosciences in the National Institute on Aging in Baltimore, MD, “suggests that [intermittent dietary energy restriction] might improve overall health and reduce risk factors for diabetes and cardiovascular disease in humans.”

He and his team say that their findings propose that a similar pattern of eating and fasting may boost the beneficial effect of moderate aerobic exercise on endurance, and that it should be studied further.

For the study, the team put mice into four groups and observed them for 2 months as they went through the following exercise and eating patterns:

The control (CTRL) mice did not exercise at all and could eat as much food as they wanted every day.

The exercise (EX) mice could eat as much daily food as they wanted, but they also ran on a treadmill for 45 minutes each day.

The “alternate day food deprivation: (ADF) mice were only fed a fixed amount on every other day and did not exercise at all.

The EXADF mice were restricted to the ADF eating pattern but also exercised every day on a treadmill for 45 minutes.

Wednesday, February 28, 2018

Wisdom Wednesday: Olfaction and the Microbiome-Gut-Brain Axis

This review covers the field of olfaction and chemosensation of odorants and puts this information into the context of interactions between microbes and behavior; the microbiome – gut – brain axis (MGBA). Recent emphasis has also been placed on the concept of the holobiome which states that no single aspect of an organism should be viewed separately and thus must include examination of their associated microbial populations and their influence. While it is known that the microbiome may be involved in the modulation of animal behavior, there has been little systematized effort to incorporate into such studies the rapidly developing knowledge of the wide range of olfactory systems.

The classical olfactory system is evolutionarily conserved in multiple taxa from insects through to fish, reptiles and mammals, and is represented by the largest gene families in vertebrates. Mice have over 1000 different olfactory receptors and humans about 400. They are distributed throughout the body and even found in spermatozoa where they function in chemotaxis. Some ectopic olfactory receptors have been shown to have functional effects in the gut and kidney, highlighting the complexity of the systems engaged by odorants. However, there are, in addition to classical olfactory receptors, at least two other families of receptors involved in olfaction that are also widely found expressed on tissues in many different organs in addition to the nervous system and brain: the trace-amine associated and formyl peptide receptors.

Bacteria can make many if not most odorants and are responsible for recognition of species and relative relatedness as well as predator presence, among many other examples. Activation of different combinations of olfactory receptors by bacterial products such as B-phenylethylamine have been shown even to control expression of emotions such as fear and aggression.

Olfaction is one of the five senses, however, it is perhaps not widely appreciated that it represents a form of chemical communication which is widely distributed and has been extensively conserved evolutionarily. Linda Buck and Richard Axel jointly received the Nobel Prize in 2004 for their discoveries of ‘odorant receptors and the organization of the olfactory system’. Their description of olfactory genes occupying roughly 3% of our total gene pool was first published in 1991.

Animals use olfaction to distinguish each other, recognize individuality and kin and even use this ability for the purposes of mate selection and preference. This is not limited to vertebrates. Indeed, bacterial synthesis of phenol was first shown to account for male sexual attraction in grass grub beetles.

Monday, February 26, 2018

Vitamin B3 Could Be Used to Treat Alzheimer’s

New research finds a compound that prevents brain damage in mice. The substance is a form of vitamin B3, and the findings suggest a potential new therapy for Alzheimer’s disease in humans.

Vitamin B3 has previously been proposed as an alternative for treating Alzheimer’s disease. In an older study, large doses of nicotinamide – also referred to as B3 – reversed Alzheimer’s-related memory loss in mice.

A new study, however, focused on the effect of nicotinamide riboside (NR), which is a form of vitamin B3, on Alzheimer’s-related brain damage in mice. NR is “critical for mitochondrial health and biogenesis, stem cell self-renewal, and neuronal stress resistance,” said Dr. Vilhelm Bohr, chief of the National Institute of Aging’s Laboratory of Molecular Gerontology.

The team added NR to the drinking water of mice that had been genetically engineered to develop the hallmarks of the neurodegenerative disorder. The mice drank the water for 3 months, and their brains and cognitive health were compared with those of the control mice. The findings were published in the journal Proceedings of the National Academy of Sciences.

Compared with the controls, the NR-treated mice had less of the protein tau in the brain, less DNA damage, and more neuroplasticity – that is, the brain’s ability to “rewire” itself when it leans new things, stores new memories, or becomes damaged. Additionally, the mice in the intervention group produced more neurons from neuronal stem cells.

Fewer neurons died or were damaged in these mice. Finally, the researchers say that in the hippocampi – a brain area involved in memory that often shrinks or is damaged in Alzheimer’s – of the mice that received the treatment, NR appeared to get rid of the existing DNA damage or stop it from spreading.

Friday, February 23, 2018

‘Too Much’ Brain Calcium May Cause Parkinson’s

Insights from a new study – by the University of Cambridge in the United Kingdom – about the role of calcium in brain cells’ signaling mechanisms brings us close to understanding the causes of Parkinson’s disease.

The presence of toxic protein deposits, or Lewy bodies, inside brain cells is a recognized hallmark of Parkinson’s disease. The deposits contain clusters of alpha-synuclein and other proteins that have folded into the wrong shape.

The new study – now published in the journal Nature Communications – shows that calcium affects the way in which alpha-synuclein binds to synaptic vesicles. Synaptic vesicles are small compartments in nerve terminals that hold the neurotransmitters, or chemical messengers, that carry signals between brain cells.

“There is a fine balance,” notes co-first author Dr. Amberley Stephens, a postdoctoral researcher in molecular neuroscience at the University of Cambridge, “of calcium and alpha-synuclein in the cell, and when there is too much of one or the other, the balance is tipped and aggregation begins, leading to Parkinson’s disease.”

Worldwide, there are more than 10 million people living with Parkinson’s disease, including around 1 million in the United States. In Parkinson’s disease, there is a progressive destruction of brain cells that produce a neurotransmitter called dopamine, which is important for controlling movement. Therefore, as the disease progresses, there will be a worsening of symptoms such as slowness of movement, rigidity, tremor, and impaired coordination and balance.

Wednesday, February 21, 2018

Wisdom Wednesday: Human Microbiome Project

This study is an extension of the Human Genome Project we reviewed last Wednesday. It began in 2008 with a goal of determining how microbes are associated with health and disease.

The initial study involved 242 “healthy” U.S. participants. Over 5,000 samples were collected, taken from 15 sites on men and 18 on women. This included mouth, nose, skin, stool and vagina. All samples were analyzed using DNA sequencing.

Researchers found that bacterial cells outnumber human cells by 10:1. Bacterial genes may outnumber human genes by 100:1. A majority of the cells were bacterial but they also found archaea (single-celled organisms), yeasts/fungus, protozoa, helminths (worms) and virus.

The human gut alone contained 1,200-1,400 species of which only 24% have been named. Another 8% have been cultured but not named. The remaining 68% have no manes and have not been cultured. Over 600 of the bacterial species documented are common to the human race in general.

Microbes contribute more to human survival than human genes do. Bacterial protein coding genes are 360 times more abundant than human genes. Microbial activities can be shared between different species. Diet, medications, and disease state can change composition and equilibrium and the microbial balance returns to a new norm that is often dysfunctional over time.

The initial colonization should be at birth. Afterward, they enter the body through ingestion of food or liquids, through the respiratory system, through a break in the skin and into the blood supply or through genital and anal openings.

The mother’s lifelong history of health will set the stage for postpartum delivery of the microbial “fingerprint”. Negative factors in this delivery are antibiotic use, GMO foods, birth control, vaccinations, stress and microbial health.

Monday, February 19, 2018

Home Remedies for Pneumonia

Pneumonia is an inflammatory disorder of the lungs caused by an infection of the airways. It is a serious condition, and home remedies cannot be used to treat it. However, they can help ease the symptoms.

Pneumonia infections can be critical and may even be life-threatening in some cases. It is essential to visit a doctor for a diagnosis, as well as to monitor symptoms and avoid any complications.

Using a blend of medical treatments and home remedies may help many people manage their symptoms more easily. Every pneumonia treatment plan will involve some antiviral, antibiotic, or antifungal medication to treat the infection.

Here are some home treatments that may help clear up the annoying symptoms of pneumonia:

peppermint and eucalyptus tea have a soothing effect on the upper respiratory tract according to a study in Evidence-Based Complementary and Alternative Medicine. Fenugreek tea appears to break down mucus based on a review in the Journal of Saudi Society of Agricultural Sciences.

Saltwater gargle may help eliminate mucus or germs in the throat and the caffeine in a cup of coffee or green tea may open the airways.

Chest pain:
ginger or turmeric tea may reduce chest pain. The roots of both plants have a natural anti-inflammatory effect in the body.

again, from the earlier study, fenugreek tea encourages a person to sweat and reduce their temperature. Hydration is also vital.

often a secondary symptom caused by a fever. When the fever breaks, the chills will typically subside. However, drinking warm liquids or a bowl of soup may help warm the body.

Friday, February 16, 2018

Cranberries for Preventing Urinary Tract Infections

Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). This is the third update of our review first published in 1998 and updated in 2004 and 2008.

Objectives – To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations.

This updated review includes a total of 24 studies with a total of 4473 participants. Thirteen studies (2380) participants) evaluated cranberry juice/concentrate; nine studies (1032) participants) evaluated cranberry tablets or capsules; one study compared cranberry juice and tablets; and one study cranberry capsules and tablets.

Many studies reported low compliance and high withdrawal/dropout problems which they attributed to palatability/acceptability of the products, primarily the cranberry juice. Most studies of the other cranberry products (tablets and capsules) did not report how much of the ‘active’ ingredient the product contained, and therefore the products may not have had enough potency to be effective.

Prior to the current update, it appeared there was some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12-month period, particularly for women with recurrent UTIs. The addition of 14 further studies suggests that cranberry juice is less effective than previously indicated. Although some of the small studies demonstrated a small benefit for women with recurrent UTIs, there were no statistically significant differences when the results of a much larger study were included. Given the large number of dropouts/withdrawals from studies and the evidence that the benefit for preventing UTI is small, cranberry juice cannot currently be recommended for the prevention of UTIs. Other preparations (such as powders) need to be quantified using standardized methods to ensure the potency and contain enough of the ‘active’ ingredient, before being evaluated in clinical studies or recommended for use.

Wednesday, February 14, 2018

Wisdom Wednesday: Human Genome Project

In 1953, James Watson and Francis Crick described the double helix structure of deoxyribonucleic acid (DNA), the chemical compound that contains the genetic instructions for building, running and maintaining living organisms.

Methods to determine the sequence of the chemical letters in DNA were developed in the mid-1970s.

In 1990, the National Institutes of Health (NIH) and the Department of Energy jointed with international partners in a quest to sequence all 3 billion letters, or base pairs, in the human genome.

The Human Genome Project’s goal was to understand the genetic factors in human disease, paving the way for new strategies for their diagnosis, treatment and prevention.

All data generated by the project was made freely and rapidly available on the Internet. This accelerated the pace of medical discovery around the world. It spurred a revolution in biotechnology innovation and made the U.S. the global leader in the arising biotechnology sector.

In April of 2003, researchers successfully completed the Human Genome Project, under budget and more than two years ahead of schedule.

Today over 1,800 genetic diseases have been discovered. There are more than 2,000 genetic tests for human conditions that enable patients to learn their genetic risks and help physicians diagnose disease. At least 350 biotech products have been developed and are in clinical trials.

Monday, February 12, 2018

Bacteria Phobia

As a society, we are obsessed with hygiene. Most of us wash our entire bodies at least once per day with hot, soapy water. Grocery store shelves are filled with antibacterial soaps that advertise they kill 99.9% of bacteria viruses. However, the testing of antibacterial soaps was not conducted on hands or kitchen surfaces. Instead, research was done in large pots where testers placed a large numbers of bacteria into liquid soap containing triclosan. After an hour, the solution was tested to see how many bacteria survive.

The safety of antibacterial soaps has never been tested. Triclosan, the most common active ingredient, has never been shown to be more effective than plain soap or even just hot water. After several years on the market Triclosan has been found in human fat tissue, umbilical cord blood, breast milk and nasal secretions. Approximately 75% of humans will pass it in their urine daily.

A clear correlation between triclosan exposure and an increased risk of infection has been documented. The greater the concentration of triclosan in nasal mucus, the higher the rate of colonization of Staphylococcus aureus. The resistant form of this bacteria you know as MRSA.

Triclosan has also been shown to interfere with the action of thyroid hormones, estrogen and testosterone. It is an endocrine disruptor at the level of the cell membrane.

In December of 2017, the FDA had a final ruling that limits the use of triclosan in certain OTC health care antiseptic products. They will not be able to use triclosan or any of the 23 other active ingredients used in antibacterial soaps “without a premarket review due to insufficient data regarding their safety and effectiveness”. Although the governor of Minnesota banned triclosan in all consumer products over concerns of bacteria developing resistance, the FDA failed to follow suit.

Friday, February 9, 2018

Vitamin and Mineral Supplements: What Clinicians Need to Know

Dietary supplementation is approximately a $30 billion industry in the United States, with more than 90,000 products on the market. In recent national surveys, 52% of US adults reported use of a least 1 supplement product, and 10% reported use of at least 4 such products. Vitamins and minerals are among the most popular supplements and are taken by 48% and 39% of adults, respectively, typically to maintain health and prevent disease.

Despite this enthusiasm, most randomized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits from primary or secondary prevention of chronic diseases not related to nutritional deficiency. Indeed, some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA) – eg, high doses of beta carotene, folic acid, vitamin E, or selenium – may have harmful effects, including increased mortality, cancer, and hemorrhagic stroke.

In this Viewpoint, we provide information to help clinicians address frequently asked questions about micronutrient supplements from patients, as well as promote appropriate use and curb inappropriate use of such supplements among generally healthy individuals. Importantly, clinicians should counsel their patients that such supplementation is not a substitute for a healthful and balanced diet and, in most cases, provides little if any benefit beyond that conferred by such a diet.