tag:blogger.com,1999:blog-46457384307001268582024-03-13T21:47:46.464-04:00Bill's BlogDr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.comBlogger799125tag:blogger.com,1999:blog-4645738430700126858.post-15506435011647794152019-06-26T10:30:00.000-04:002019-06-26T10:30:00.268-04:00Wisdom Wednesday: RNA<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" /></a></div><br />
Ribonucleic acid or RNA acts as a messenger between DNA and the protein synthesis complexes known as ribosomes, forms vital portions of ribosomes, and acts as an essential carrier molecule for amino acids to be used in protein synthesis.<br />
<br />
RNA is very similar to DNA, but differs in a few important structural details: RNA is single stranded, while DNA is double stranded. Also, RNA nucleotides contain ribose sugars while DNA contains deoxyribose and RNA uses predominantly uracil instead of thymine present in DNA.<br />
<br />
RNA is transcribed from DNA by enzymes called RNA polymerases and further processed by other enzymes. RNA serves as the template for translation of genes into proteins, transferring amino acids to the ribosome to form proteins, and also translating the transcript into proteins.<br />
<br />
RNA is a polymer with a ribose and phosphate backbone and four different bases: adenine, guanine, cytosine, and uracil. The first three are the same as those found in DNA, but in RNA thymine is replaced by uracil as the base complementary to adenine.<br />
<br />
Uracil is energetically less expensive to produce than thymine, which may account for its use in RNA. Having thymine as the normal base in DNA makes detection and repair of incipient mutations more effective. Thus uracil is appropriate for RNA, where quantity is important but lifespan is not, whereas thymine is appropriate for DNA where maintaining sequence with high fidelity is more critical.<br />
<br />
<a name='more'></a><br />
<br />
<b>My Take:</b><br />
Aren’t you glad I cut out some of the technical jargon? In simpler terms, RNA is a mirror image made from the template of DNA. RNA is used to make proteins that primarily function as enzymes in the body, catalyzing specific chemical reactions.<br />
<br />
RNA is also cut into smaller pieces, made into a double helix (microRNA) than transformed into mature mRNA in the cytoplasm of the cell. mRNA directs cell differentiation by inhibiting specific DNA transcription. (See my blog on microRNA posted last week) This allows the body to produce different cells – heart, liver, skin, etc. from the same DNA.<br />
<br />
RNA is available as a supplement from Standard Process. I use it to improve brain function. It is especially effective for those with short term memory issues or people having difficulty with multi-tasking.<br />
<br />
A simple test for RNA is to stand on one foot with your arms extended out from your side. Steady yourself, then close your eyes. If you can maintain your balance for several seconds with your eyes closed, your RNA levels are probably adequate. If you fall quickly, then RNA supplementation may be beneficial. It’s a good idea to have someone close by to catch you when you fall.<br />
<br />
<b>Bottom Line:</b><br />
RNA is a fascinating area of study and research into microRNA is currently at a fever pitch. However, practical supplementation of RNA has been available since 1952.<br />
<br />
Source: Science DailyDr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-11602217278955841292019-06-24T16:22:00.003-04:002019-06-24T16:22:34.032-04:00Decaf CoffeeDecaffeinated coffee, or "decaf," is similar in taste and appearance to regular coffee but contains very little caffeine. There is no evidence to suggest that drinking decaf is bad for a person's health, and it may even share some of the health benefits of regular coffee.<br />
<br />
According to a 2017 research review, decaf coffee is similar in composition to regular coffee but contains little or no caffeine. To remove the caffeine, manufacturers soak or steam unroasted coffee beans using a combination of water and other chemicals, such as: activated charcoal, supercritical carbon dioxide, methylene chloride and ethyl acetate. Manufacturers use water because caffeine is a water-soluble substance. However, using water by itself may remove other compounds, such as proteins and sugar, from the coffee beans. Using additional chemicals speeds up the decaffeination process, which minimizes the loss of noncaffeine compounds and helps preserve the distinct coffee flavor.<br />
<br />
One 2-17 study reviewed 201 meta-analyses of observational research into coffee consumption. Its authors concluded that decaf coffee does not appear to have any harmful health effects. However, the use of methylene chloride in the decaffeination process has raised some concern among members of the coffee community as well as some consumers.<br />
<br />
Inhaling even small amounts of methylene chloride — around 200 parts per million (ppm) in the air — can temporarily slow down the central nervous system and affect a person's attention and hand-eye coordination. Mild exposure can also lead to symptoms such as: headache, drowsiness, lightheadedness, irritability, coughing or wheezing<br />
<br />
<a name='more'></a><br />
<br />
The FDA has approved the use of methylene chloride in the caffeine extraction process as long as the final product contains no more than 10 ppm, or 0.001%, of residual methylene chloride.<br />
Despite its name, decaf coffee does still contain some caffeine.<br />
<br />
According to the United States Department of Agriculture (USDA), a typical 8 ounce (oz) cup of decaf coffee contains 2mg of caffeine. However, the caffeine content can vary by brand, with some decaf coffees containing up to 15mg per 8 oz cup. According to the FDA, an 8 oz cup of regular coffee typically contains 80–100 mg of caffeine.<br />
<br />
Green and black teas also contain more caffeine than decaf coffee. A regular 8 oz cup of green or black tea usually contains about 30-50mg of caffeine.<br />
<br />
A growing body of scientific research suggests that coffee contains several compounds that are beneficial to human health. For example, a large 2017 review suggests that drinking coffee can lower a person's risk of developing certain cancers. However, much of the research looked at the health benefits of regular coffee, with few studies focusing on decaf coffee specifically. So, it is not clear whether the health benefits of regular coffee extend to decaf.<br />
<br />
That said, the authors of the 2017 review did find a link between drinking decaf and a reduced risk all-cause mortality and death from cardiovascular causes. The researchers observed the greatest risk reduction in people who drank two to four cups per day.<br />
<br />
<b>My Take:</b><br />
Methylene chloride is also used in paint strippers and has been deemed responsible for the deaths associated with the use of these products. Ethyl acetate is used in nail polish. As an organic solvent, it is what makes the odor from nail polish so strong. Besides being extremely flame able, it is toxic when ingested or inhaled.<br />
<br />
<b>Bottom Line:</b><br />
Avoid decaf coffee unless it is naturally decaffeinated using the Swiss water process. This process soaks the beans in carbon dioxide, removing 97% of the caffeine.<br />
<br />
Source: June 18, 2019 NIHDr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-21559213830922291022019-06-21T10:30:00.000-04:002019-06-24T16:21:42.486-04:00Gut bacteria: The surprising impact of virusesThe microbiome plays a vital role in health. A recent study has investigated how viruses that kill gut bacteria influence these microbes. The findings make an already complicated picture much more so. The microbiome is both fascinating and fashionable.<br />
The increase in public interest has provided a boost in funding to study the interactions between us and our gut bacteria. Scientists have now found relationships between the microbiome and a range of conditions, from diabetes and obesity to Parkinson's and depression.<br />
<br />
Thanks to gut bacteria's high profile, grocery stores shelves are now brimming with probiotic products. Despite their wide availability and popularity, however, there is little evidence to suggest that they provide many benefits outside a small number of specific conditions. Although scientists know that the microbes within us are vital, designing a way to moderate them to improve health and fight disease is still a long way off.<br />
<br />
The primary reason for this is the dazzling complexity of the microbiome. It is not a single, homogenous entity, but a world of microscopic beings that interact, influence, and inhibit their neighbors, capable of killing, nourishing, and communicating with each other. Already, at this point, we can see the vast difficulties in understanding the ins and outs of the microbiome, but some researchers are examining the next level of complexity: bacteriophages.<br />
<br />
<a name='more'></a><br />
<br />
Bacteriophages, or simply phages, are viruses that exclusively destroy bacteria. Incredibly, phages outnumber bacteria; where there are bacteria, there are phages in spades.<br />
Phages are specific, too; they tend to destroy just one species or strain of bacteria. Before the advent of antibiotics, scientists used phages to fight infections. However, when researchers discovered antibiotics, they took the place of phages; antibiotics were cheaper and easier to produce than phages. Now, with antibiotic resistance on the rise, some researchers are revisiting the idea of phage therapy.<br />
<br />
Of course, if phages kill bacteria, they are likely to influence the microbiome. Researchers from the Brigham and Women's Hospital and the Wyss Institute, both in Boston, MA, are interested in exactly how these abundant viruses might impact our gut bacteria. They published the results of their most recent study in the journal Cell Host & Microbe.<br />
<br />
To investigate, the researchers used gnotobiotic mice; they reared these animals in such a way that they have no bacteria living on or in them. To begin, they introduced to the mice 10 species of bacteria that commonly reside in the human gut, including Enterococcus faecalis and Escherichia coli.<br />
Then, they added phages that specifically target the bacteria they transplanted into the mice. For instance, the T4 phage targets E. coli, and the VD13 phage attacks E. faecalis. They then tracked the success of each microbe.<br />
<br />
The scientists showed that although any given phage attacked only one species of bacteria, that phage would also impact other species; some species thrived while others dwindled.<br />
Looking at the wider picture, the researchers also assessed the array of compounds produced by both the bacteria and the mouse; this is called the metabolome.<br />
<br />
They found that when they introduced a phage to the mice and the bacterial composition changed, there were also changes in the levels of certain biologically active chemicals. The study authors write: In other words, a single strain of a virus can alter the type or quantity of biological molecules available to the host animal.<br />
<br />
<b>My Take:</b><br />
As I have repeatedly warned, your microbiome is unique. We just don’t know what probiotics live in your microbiome, so taking any probiotic is not without risk of damaging the microbiome or even triggering an autoimmune response.<br />
<br />
Phage therapy holds a lot of promise and hopefully fills the void created by abuse of antibiotics over the past 50 years. I was not aware that phage therapy had been studied prior to the introduction of antibiotics during WWII.<br />
<br />
<b>Bottom Line:</b><br />
Do everything you can to preserve and support your microbiome – eat fermented foods, take a prebiotic, increase the fiber in your diet. However, avoid probiotic supplementation unless a specific condition calls for short term use.<br />
<br />
Source: June 19, 2019 NIH<br />
<br />
<br />
Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-85350454794132213392019-06-19T10:30:00.000-04:002019-06-24T16:24:42.067-04:00Wisdom Wednesday: Research Study on the Effectiveness of Stem Cell Injections<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" /></a></div><br />
Between June 2014 and February 2017, data from 233 patients with knee osteoarthritis treated with BMAC injection at a single center were retrospectively evaluated. Only patients with idiopathic osteoarthritis were included. Exclusion criteria were post-traumatic osteoarthritis, previous knee surgery, age less than 50 years old or more than 85 years old, active infection, uncontrolled diabetes mellitus, rheumatological or other systemic disease, malignancy, or treatment with immunosuppressive drugs. Bone marrow from the iliac crest was aspirated/concentrated with a standardized technique using a single-spin manual method. Patients were evaluated before and after the procedure, using the numeric pain scale (NPS) and Oxford knee score (OKS). Mean follow-up period was 11 months, range (6e30 months). A total of 121 of 233 patients had completed data as previously defined and were included in the statistical analysis. There were 85 females and 36 males, with mean age 70 years (range 50e85). Compared to baseline, the mean NPS decreased from 8.33 to 4.49 (p 0.001) and the mean OKS increased from 20.20 to 32.29 (P 0.001) at final follow-up. There were no complications. A single intra-articular injection of BMAC is a safe and reliable procedure that results in clinical improvement of knee OA.<br />
<br />
<b>My Take:</b><br />
This is just the summary of the full article which Apex was kind enough to send to me. The published study listed any conflicts of interest, financial support and most importantly limitations of the study. The study was self-supported by the clinic in Greece that performed all the procedures without any outside financial support. <br />
<br />
<a name='more'></a><br />
<br />
There were significant limitations. The first and foremost was that there was no control group. The second was that the study was retrospective, not allowing follow-up at regular intervals. Follow-up varied case by case. Third, the study only involved advanced cases of osteoarthritis (grade 3 and 4). The authors believe this is because the culture of Greece leans toward having several orthopedic interventions and only seeking this type of care when joint replacement has been recommended. There is no data on how effective this procedure might be with mild cases of osteoarthritis. Fourth, the authors believe there is a bias toward their procedure from “word of mouth” from former patients toward prospective patients. <br />
<br />
Last, there was no laboratory analysis of the variable components of the BMAC concentrate. They take 60ml of fluid from the bone marrow, then centrifuge the aspirate carefully and extract 20ml of the “buffy coat”. This is the fluid between the plasma and packed cells. It contains variable amounts of serum and packed red blood cells, along with hematopoietic stem cells, platelets, growth factors (GFs), cytokines and chemokines. The BMAC is full of good stuff but undoubtedly varies from procedure to procedure.<br />
<br />
<b>Bottom Line:</b><br />
Despite all the limitations, the results from just one injection of BMAC on advanced osteoarthritis are remarkable. As a patient suffering from early osteoarthritis of the hip, I would much prefer single intra-articular injection of BMAC to any surgical intervention. I would be open to repeat the procedure as needed rather than face a hip joint replacement. The fact that 86% of the patients would recommend the therapy and there were no reported side effects speaks volumes. Watch for this procedure to be available in the United States.<br />
<br />
Source: June 14, 2019 Apex Biologix <br />
<br />
<br />
<br />
<br />
Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-48739182192714322032019-06-17T15:35:00.002-04:002019-06-17T15:35:19.136-04:00NAFLDSedentary lifestyles, nutrient-poor diets, chemical exposure, and an excess of sugar and refined foods are wreaking havoc on and in our bodies more than ever before. And the effects aren’t just cosmetic – beyond bulging waistlines, the incidence of high blood pressure, high blood sugar, and high cholesterol associated with metabolic syndrome are all on the rise, along with the rate of nonalcoholic fatty liver disease (NAFLD).<br />
<br />
As the name implies, NAFLD (casually pronounced “naffled”) is a condition in which the liver stores excess fat occurring in those who drink little to no alcohol. Over time NAFLD can not only increase the risk of cardiovascular disease, but can also lead to further ailments of the liver like cirrhosis and liver cancer – conditions also seen in heavy alcohol consumers, but now more commonly seen in non-drinkers. In fact, NAFLD is the leading cause of liver disease in the West, often concurrent with other metabolic conditions: approximately 40 to 80% of people with the disease also have type 2 diabetes, and 30 to 90% are obese. As with metabolic syndrome, the incidence of NAFLD is also on the rise among children, affecting an estimated 3 to 12% of children with normal body mass and an alarming 40 to 80% of obese children.<br />
<br />
The umbrella term NAFLD encompasses two sub-categories: nonalcoholic fatty liver (NAFL), which is characterized by fatty liver with little to no inflammation; and nonalcoholic steatohepatitis (NASH), which is the more harmful of the two and is defined as fatty liver with inflammation. It’s estimated that 30 to 40% of American adults have NAFL and about 3 to 12% have NASH. <br />
<br />
<a name='more'></a><br />
<br />
The causes of NAFLD are not fully known, but a large piece of the puzzle has to do with the liver holding onto excess triglycerides. Triglycerides (TGs) are a form of fat that the body produces from excess calories, such as those that come from carbohydrates and sugar. Insulin resistance and blood sugar levels clearly play a role in the progression of NAFLD, which may very well explain why so many individuals with the disease are also diabetic. It has also been demonstrated that oxidative damage further exacerbates the situation, contributing to the progression of NASH.<br />
<br />
But what causes that oxidative injury? It’s still being researched, but some explanations include iron overload conditions (like hemochromatosis), low antioxidant defenses, and an over-abundance of opportunistic or pathogenic bacteria in the gut (also known as dysbiosis), which contributes to inflammation and “leaky gut.” <br />
<br />
<b>My Take:</b><br />
I think NAFLD should be considered another aspect of metabolic syndrome. Clinically, I suspect NAFLD when a patient has a slightly elevated fasting glucose, but their gycohemoglobin A1c is normal. One or more of their liver enzymes (SGOT, SGPT, GGT) may also be elevated.<br />
Elevated triglycerides are typically elevated when patients consume a lot of refined carbohydrates, but if triglycerides remain high after cleaning up their diet, NAFLD must be considered.<br />
<br />
The diagnosis is confirmed with an ultrasound of the liver, demonstrating fatty infiltration. As long as there is no evidence of scar tissue (cirrhosis), then the condition is reversible. However, traditional medicine has not yet developed any drug therapy for NAFLD.<br />
Diet, exercise and nutritional supplementation are the keystones to reversal of NAFLD. Silymarin, phosphatidal choline, oil soluble chlorophyll, and support for any other aspects of metabolic syndrome are effective adjuncts.<br />
<br />
<b>Bottom Line:</b><br />
If you have high triglycerides, any aspects of metabolic syndrome (high blood pressure, obesity, high serum lipids, insulin resistance, or hypothyroidism), or elevated liver enzymes please consult your PCP to test for NAFLD. However, if you suffer from NAFLD seek qualified nutritional evaluation and treatment.<br />
<br />
Source: June 13, 2019 Allery Research CorporationDr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-70176510617857294822019-06-14T10:30:00.000-04:002019-06-17T15:33:59.869-04:00Almond, hemp, oat, soy, and cow's milk: Which is best?The number of people choosing nondairy, plant-based alternatives to cow's milk appears to be growing. So, how do these different milks compare nutritionally? Research from 2018 says that eating and drinking milk that comes from cows has been falling, with interest in alternative milks rising.<br />
<br />
One of the main medical reasons why people choose plant-based milk products is to avoid symptoms of lactose intolerance or a cow milk protein allergy. Doctors estimate the incidence of this allergy is 2 to 5% in children under 3 years old. The incidence is lower in adults.<br />
Some people may also choose plant-based milk products because they believe they are more sustainable, ethical, or healthful options compared to cow's milk.<br />
<br />
Almond milk is one of the most widely consumed plant-based milk variety in North America, the European Union, and Australia. Researchers have suggested that almond milk is an effective alternative for children and adults who suffer with allergies or intolerances to milk. Compared to cow's milk, almond milk has less saturated fat and more unsaturated fats. The healthful fats in almond milk may help people lose weight and keep it off. Almond milk is low in calories and protein, which may not be suitable for all people, especially children.<br />
<br />
Some manufacturers add calcium to almond milk to better resemble the nutritional content in cow's milk. People may not be able to absorb as much of this calcium as they would from dairy, so they should be sure to consume plenty of other calcium sources, such as dark green vegetables. Almond milk is available in flavored varieties. Some of these products have added sugar to extend the shelf life and improve the flavor and texture.<br />
<br />
Unflavored hemp beverages are also low in calories and protein compared with cow's milk. There is, however, more protein in hemp beverages than in almond milk. Hemp seeds are also high in polyunsaturated fats, similarly to almond milk. Research shows that replacing saturated fats with these more healthful fats can help lower a person's overall cholesterol.<br />
<br />
<br />
<a name='more'></a><br />
<br />
Hemp milk will not separate in hot drinks, so people can add it to their coffee and tea.<br />
Some people may not like homemade hemp milk because of its earthy taste and chalky texture. Store-bought varieties have additional ingredients that help to mask the taste and texture.<br />
<br />
Oat milk has a mild, creamy flavor that makes it good for cereals, hot beverages, and drinking on its own. Oat milk is not suitable for people with gluten intolerance or with celiac disease.<br />
Unflavored oat milk has the highest amount of calories and carbohydrates of plant-based milk varieties. Although the sugar is natural, oat milk is very high in carbohydrates.<br />
<br />
Soy milk is the most common substitute for cow's milk and the first plant-based alternative to appear on the market in the United States. The 2015–2020 Dietary Guidelines for Americans suggests that people with lactose intolerance consume fortified soy beverages as an alternative to cow's milk. When people compare soy milk with almond, hemp, and oat milk, this milk alternative has the highest amount of protein per serving. As with many other plant-based milk varieties, soy milk manufacturers often add calcium and vitamin D.<br />
<br />
Plant-based milk varieties have high levels of phytate and oxalate, which are compounds that can block the absorption of calcium. According to the 2019 review in the journal Nutrients, experiments on soy milk show that despite the presence of these compounds, calcium absorption was similar to that of cow's milk if the manufacturers fortified it with calcium carbonate.<br />
<br />
Although soy milk has more protein than other plant-based milk products, cow's milk has higher amounts of the essential amino acids methionine, valine, leucine, and lysine. People also consume soy milk because it has isoflavones, which researchers suggest have anticancer effects. Doctors may also recommend that children under 3 years old with cow milk protein allergy avoid drinking soy milk, as they may also be allergic to soy. Farmers use a variety of pesticides when growing soybeans, so people who want to avoid pesticides may wish to choose organic brands.<br />
<br />
<b>My Take:</b><br />
Soy milk also contains phytoestrogens which can disrupt hormone receptor pathways. I recommend staying away from all but naturally fermented soy. Cow’s milk has all the contamination issues of soy and then some. Avoid it as well.<br />
<br />
<b>Bottom Line:</b><br />
If you want dairy in your diet, stick to yogurt and hard cheeses. For milk, I prefer almond, but hemp and oat milk are also good choices as well.Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-63329333231370787322019-06-10T10:30:00.000-04:002019-06-10T16:13:50.233-04:00Common heartburn drug linked with fatal conditionsNew research suggests that drugs commonly used for heartburn, acid reflux, and ulcers may raise the risk of numerous fatal conditions, including heart disease and stomach cancer. Physicians often prescribe proton pump inhibitors(PPIs) to treat gastrointestinal conditions that involve an excess of acid production. Nexium, Aciphex, Zegerid, Dexilant, Prevacid, Prilosec, and Protonix are only some of the brand names that PPIs have taken over the years.<br />
<br />
More than 15 million people in the United States take prescription PPIs, according to the most recent statistics available, and even more may be taking over-the-counter PPIs.<br />
A new study, appearing in the journal The BMJ, suggests that these drugs may increase the risk of death from various chronic health conditions.<br />
<br />
Dr. Ziyad Al-Aly, an assistant professor of medicine at the Washington University School of Medicine in St. Louis, MO, is the senior investigator of the study. For the new study, Dr. Al-Aly and colleagues examined data from the medical records of the U.S. Department of Veterans Affairs.<br />
<br />
The researchers looked at data available from mid-2002 to mid-2004, a period during which 157,625 people in the cohort received PPI prescriptions from their physicians and 56,842 people received H2 blockers, another kind of acid suppressant.<br />
<br />
The scientists clinically followed the participants — who were predominantly male, Caucasian, and 65 years old or older — for up to a decade. They used the data to build a statistical model of a clinical trial, which would see the participants randomly assigned to take either PPI or H2 blockers. This allowed them to estimate that during the follow-up period, there would be 45.2 excess deaths per every 1,000 individuals taking PPIs.<br />
<br />
<a name='more'></a><br />
<br />
Honing in on the causes of death, the findings revealed associations with cardiovascular disease, stomach cancer, and chronic kidney disease. The model estimates the death rates for cardiovascular disease to be 88.7 per 1,000 people in the PPI group and 73.3 per 1,000 people in the H2 blocker group.<br />
<br />
The scientists saw 4.3 deaths in every 1,000 people from stomach cancer in the PPI group, with 4.6 deaths from the disease in the H2 blocker group in their model. The rates for chronic kidney disease deaths were 8.6 per 1,000 people in the PPI group and 4.4 in the H2 blocker group.<br />
Also, the risk of death increased with the duration of the treatment, even when the study participants had taken low doses of the drug.<br />
<br />
Finally, the research revealed that over half of those taking PPIs had no medical need for them. "Most alarming to me is that serious harm may be experienced by people who are on PPIs but may not need them," comments Dr. Al-Aly. "Overuse is not devoid of harm."<br />
<br />
<b>My Take:</b><br />
This was a long article, so I’ll keep it short. The last paragraph says it all. When our elderly population moves into retirement communities. Typically, a medication review is performed. PPIs, antidepressants, and sleep aids are the first medications to be discontinued as unnecessary and harmful.<br />
<br />
<b>Bottom Line:</b><br />
PPI use should be limited to two weeks as the research recommends. Continued use has long been associated with anemia, malnutrition and osteoporosis. Now you can add fatal diseases like heart disease and stomach cancer to that list.<br />
<br />
Source: June 4, 2019 NIHDr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-42441781245227203912019-06-07T10:30:00.000-04:002019-06-10T16:12:42.556-04:00Gluten Free?While gluten-free dining options have been steadily increasing, new research has elucidated that there may still be gluten in your “gluten-free” foods. While packaged foods labeled as gluten-free must contain less than 20 parts per million of gluten, there is no similar standard for gluten-free restaurant foods.<br />
<br />
A study, published in The American Journal of Gastroenterology in March 2019, reported that a significant amount of restaurant foods classified as gluten-free contain detectable amounts of gluten. The study had participants use a portable device called a Nima Gluten Sensor to test their food. 804 users conducted 5,624 tests in an 18-month period.<br />
<br />
The results revealed that gluten was detected in 32% of the foods that were designated gluten-free. Interestingly, the researchers found that gluten detection differed by meal and type of food with the most gluten detection occurring at dinner and more than 50% of pizza and pasta samples testing positive for gluten. Additionally, when stratified by region, researchers found that gluten contamination was less likely to occur in the West than in the Northeast regions of the United States.<br />
<br />
These results support the fact that there is gluten contamination in restaurant foods. It should be noted that the Nima device is very sensitive and can detect gluten at 5-10 parts per million, which has unknown clinical significance for those with celiac disease. Nevertheless, this study highlights the prevalence of gluten contamination in restaurants and brings to light the importance of finding gluten-free menus you can trust. The study concluded that their “findings of higher rates of gluten detection in pizza and pasta provide practical data when providing dining strategies for patients with celiac disease”.<br />
<br />
<a name='more'></a><br />
<br />
<b>My Take:</b><br />
Gluten sensitivity is much more prevalent then true celiac disease. As I have noted in previous blogs, the gluten content in wheat has increased by 400% since the early 1960s in an attempt to make the wheat stalk stronger and more bug resistant. Apparently, if the gluten content is high enough, even the bugs will not eat it. I believe we all are sensitive to gluten if the exposure is high enough.<br />
Technically, it glutens, not gluten as they are actually a family of proteins, rather than one specific substance. People are typically sensitive to the one form and not another.<br />
<br />
Most of us would see significant improvement in our health and well-being by just reducing our grain intake in general. Grains remain an inexpensive food that provides a lot of empty calories. You can keep people alive with grains but they are low in the micronutrients we need to sustain true health. Modern processing of grains has only exacerbated the situation.<br />
<br />
<b>Bottom Line:</b><br />
If you are trying to avoid gluten(s), do not assume that a product that says it is gluten free is, in fact, gluten free. This is especially true when dining out. If the food naturally contains gluten, it is best to just avoid it.<br />
<br />
Source: May 16, 2019 Biotics ResearchDr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-47702011402663125222019-06-05T10:30:00.000-04:002019-06-05T13:27:23.217-04:00Wisdom Wednesday: Improved Quality of Life with Magnesium<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" /></a></div><br />
Recent research looked at the disability levels, quality of life, and anxiety and depressive symptoms in 34 children aged 7-17 after six months of magnesium prophylaxis for pediatric migraines. According to the researchers, “After 6 months of magnesium prophylaxis, disability due to migraine significantly decreased, whereas physical and psychosocial well-being improved.”<br />
<br />
Magnesium is the fourth most abundant mineral in the body and is a cofactor for more than 300 enzyme systems regulating a variety of chemical reactions in the body. Magnesium is involved in protein synthesis, muscle and nerve function, blood sugar control, and regulation of blood pressure. Magnesium is also involved in energy production as it is necessary for ATP production and glycolysis. Magnesium also contributes to the structural development of bone and is necessary for the synthesis of DNA and RNA.<br />
<br />
Magnesium is important for detoxification as it is needed to product glutathione. Magnesium also plays a role in the active transport of calcium and potassium ions across cell membranes, a process that is important to nerve impulse conduction, muscle contraction, and normal heart rhythm. Other studies also show a link between low magnesium and headaches.<br />
<br />
<a name='more'></a><br />
<br />
<b>My Take:</b><br />
Biotics sends me periodic updates that have a format similar to my blog. I have written about magnesium several times over the past five years. To review those blogs just type magnesium in the search box in the upper left hand corner of my blog site.<br />
Clinically, I use magnesium most often to control heart rate. It is especially effective in the treatment of tachycardia (rapid heart rate) but is also a vital component in the treatment of Afib (atrial fibrillation) as well.<br />
<br />
Magnesium can be titrated to tolerance. Start at 100mg per day and increase by 100mg per day until the stool becomes loose. At that point you are unable to absorb this amount of magnesium. It is being passed to the large intestine where it over stimulates the bowel. This is the reason magnesium is often misused as a laxative.<br />
<br />
Now reduce the magnesium by 100mg and the stool should return to normal. Over time, if you are restoring proper magnesium levels from a deficiency, the loose stool may return again. This indicates the need to reduce daily supplementation further.<br />
<br />
The opposite is also true. During times of stress, your need for magnesium may increase dramatically. You may be able to increase the dosage without the laxative effect until the stressor is relieved. Then the loose stool will return indicating a reduction in dose is warranted.<br />
<br />
I typically take 300mg of magnesium daily. However, during preparations for Hurricane Irma, I had to increase my daily dose to 1200mg to control my tachycardia. Once the path of the storm moved west, I slowly returned to 300mg based on my stool.<br />
<br />
More recently, I had a series of injuries that curtailed my regular exercise. I experienced a few episodes of tachycardia and had to increase my magnesium to 400mg daily. As I return to exercise, I suspect the daily dose to drop again.<br />
<br />
<b>Bottom Line:</b><br />
Magnesium is an important mineral in the body and often needs supplementation to the daily diet. Use the consistency of your stool as a guide, but don’t use magnesium as a daily laxative.<br />
<br />
Source: May 30, 2019 Biotics Research <br />
<br />
Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-62751095536229448352019-06-03T10:30:00.000-04:002019-06-05T13:25:06.945-04:00CinnamonCommon Names: cinnamon, cinnamon bark, Ceylon cinnamon, cassia cinnamon<br />
<br />
Latin Name: Cinnamomum verum (also known as Cinnamomum zeylanicum), Cinnamomum cassia<br />
<br />
There are many types of cinnamon. Cassia cinnamon, native to China, is the most common type sold in the United States and Canada. Ceylon cinnamon, native to Sri Lanka, is common in other countries and is known as “true” cinnamon.<br />
<br />
Used as a spice for thousands of years, cinnamon comes from the bark of the cinnamon tree. Essential oils are made from the bark, leaves, or twigs of cassia cinnamon.<br />
<br />
Cinnamon has a long history as a traditional medicine, including for bronchitis.<br />
Today, some people use cinnamon as a dietary supplement for gastrointestinal problems, loss of appetite, and diabetes, among other conditions.<br />
<br />
Cinnamon is used in capsules, teas, and extracts.<br />
<br />
Studies done in people don’t support using cinnamon for any health condition.<br />
<br />
A 2012 systematic review of 10 randomized controlled clinical trials in people with type 1 or type 2 diabetes suggests that cinnamon doesn’t help to reduce levels of glucose or glycosylated hemoglobin A1c (HbA1c), a long-term measure of glucose (blood sugar) control.<br />
A product containing cinnamon, calcium, and zinc didn’t improve blood pressure in a small study of people with type 2 diabetes.<br />
<br />
National Center for Complementary and Integrative Health (NCCIH)-supported research is looking at the effect of cinnamon on processes involved in multiple sclerosis.<br />
<br />
<a name='more'></a><br />
<br />
Cinnamon supplements appear to be safe for most people for short-term use if not taken in large amounts. Some people may have allergic reactions to cinnamon.<br />
<br />
Cassia cinnamon contains varying amounts of a chemical called coumarin, which might cause or worsen liver disease. In most cases, cassia cinnamon doesn’t have enough coumarin to make you sick. However, for some people, such as those with liver disease, taking a large amount of cassia cinnamon might worsen their condition.<br />
<br />
Cinnamon should not be used in place of conventional medical care or to delay seeking care if you have health problems. This is particularly true if you have diabetes.<br />
<br />
<b>My Take:</b><br />
The National Center for Complimentary and Integrative Health is a branch of the National Institutes of Health. This fact sheet is very middle of the road as might be expected from a government site. However, it minimizes the risk of liver disease from taking the most common form of cinnamon, Cassia. A 150 pound man taking as little as a ¼ teaspoon daily could suffer liver damage from the levels of coumarin naturally occurring in Cassia. Coumarin has been a banned substance in the United States for several years. However, foods naturally containing coumarin are not regulated. This should give you pause as Cassia cinnamon is the most popular form on today’s market, sold in every grocery and health food store.<br />
<br />
<b>Bottom Line:</b><br />
Use Ceylon cinnamon for foods and supplementation. It’s a bit more expensive than Cassia cinnamon, but the levels of coumarin are much lower.<br />
<br />
Source: National Center for Complimentary and Integrative Health<br />
<br />
<br />
<br />
Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-41022477659927064722019-05-31T10:30:00.000-04:002019-06-05T13:23:26.489-04:00High uric acid directly inhibits insulin signaling and induces insulin resistanceAccumulating clinical evidence suggests that hyperuricemia is strongly associated with abnormal glucose metabolism and insulin resistance. However, how high uric acid (HUA) level causes insulin resistance remains unclear. We aimed to determine the direct role of HUA in insulin resistance in vitro and in vivo in mice.<br />
<br />
An acute hyperuricemia mouse model was created by potassium oxonate treatment, and the impact of HUA level on insulin resistance was investigated by glucose tolerance test, insulin tolerance test and insulin signaling, including phosphorylation of insulin receptor substrate 1 (IRS1) and Akt. HepG2 cells were exposed to HUA treatment and N-acetylcysteine (NAC), reactive oxygen species scavenger; IRS1 and Akt phosphorylation was detected by Western blot analysis after insulin treatment.<br />
<br />
Hyperuricemic mice showed impaired glucose tolerance with insulin resistance. Hyperuricemia inhibited phospho-Akt (Ser473) response to insulin and increased phosphor-IRS1 (Ser307) in liver, muscle and fat tissues. HUA induced oxidative stress, and the antioxidant NAC blocked HUA-induced IRS1 activation and Akt inhibition in HepG2 cells.<br />
<br />
This study supplies the first evidence of HUA directly inducing insulin resistance in vivo and in vitro. Increased uric acid level may inhibit IRS1 and Akt insulin signalling and induce insulin resistance. The reactive oxygen species pathway plays a key role in HUA-induced insulin resistance.<br />
<br />
<a name='more'></a><br />
<br />
<b>My Take:</b><br />
This is the abstract straight from PubMed. This study was mentioned in a seminar I took on blood chemistries last month.<br />
<br />
Measurement of uric acid levels used to be a common component of routine laboratory testing. However, I rarely see the UA levels as a part of a comprehensive metabolic profile. I added it back to my routine testing a few years ago.<br />
<br />
It has long been known that insulin resistance and diabetes causes kidney damage. We now know that the reverse is also true – loss of kidney function can cause insulin resistance and lead to diabetes.<br />
<br />
In addition to looking at the BUN (blood urea nitrogen), creatinine, and uric acid on your yearly lab work, pay close attention to the eGFR (estimated glomerular filtration rate). I have written several blogs about this test, so please type “GFR” in the search box in the upper left hand corner of my blog site to review previous blogs on this topic.<br />
<br />
An eGFR below 60 indicates kidney damage. However, an eGFR between 60 and 95 indicates loss of kidney function. Medically this functional loss is typically ignored. Some labs still list the result as <59 95.="" a="" and="" any="" assign="" b="" don="" egfr="" ignore="" less="" number="" please="" rather="" review="" t="" test.="" than="" the="" to="" value="" your="">Bottom Line:</59><br />
high uric acid is an important factor in the onset of insulin resistance and diabetes. Please have your uric acid levels checked as a part of your yearly physical and address any abnormal findings with your physician.<br />
<br />
May 14, 2014 NIH Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-296818919428729742019-05-24T10:30:00.000-04:002019-05-28T16:06:16.560-04:00'Clear Relationship' Between Appendectomy and Parkinson'sAn analysis of the health system records of more than 62 million people in the United States has found a link between appendix removal and raised risk of developing Parkinson's disease.<br />
<br />
The researchers compared data on people who had undergone an appendectomy, or appendix removal, to those who had not were more than three times more likely to develop<br />
Parkinson's disease later on. The findings are further evidence of a connection between the gut and the brain in Parkinson's disease.<br />
<br />
In a gastroenterology abstract about the study, the authors suggest that what is missing from the research on appendix removal and Parkinson's disease risk is "large-scale epidemiological data." Lead study author Dr. Mohammed Z. Sheriff, who works as a physician at University Hospitals Cleveland Medical Center and Case Western Reserve University, also in Cleveland, OH, is presenting the findings at the 2019 Digestive Disease Week meeting that takes place May 18–21 in San Diego, CA.<br />
<br />
Parkinson's is a disease that gradually destroys cells in a part of the brain that helps control movement. The symptoms of Parkinson's include movement rigidity, tremor, slowness, and balance difficulties. Because it most often strikes older people, the number and proportion of individuals living with Parkinson's disease are rising in aging populations. As yet, there is no cure and no treatment that slows down Parkinson's disease. An avenue that scientists are pursuing concerns alpha-synuclein, which is a protein that features in the development of Parkinson's disease. Although it is not clear what function it serves in those without the disease, alpha-synuclein forms toxic clumps called Lewy bodies in the brains of people with Parkinson's disease. Dr. Sheriff says that more recent research has found clumps of alpha-synuclein in the digestive tract of people in the early stages of Parkinson's disease.<br />
<br />
<a name='more'></a><br />
<br />
Of the 62.2 million patient records that they analyzed, the team identified 488,190 people who had undergone an appendectomy. Of these, 4,470 individuals (0.92%) went on to receive a diagnosis of Parkinson's disease. Of the remaining 61.7 million people, only 177,230 individuals (0.29%) received a Parkinson's disease diagnosis. The team also found that the more than three times higher likelihood of developing Parkinson's disease following an appendectomy was not dependent on age, sex, or race.<br />
<b><br />
My Take:</b><br />
Medical science has long held that the appendix is a vestigial organ, having no function in the human body. While some sceptics say that it is the surgery itself rather than the removal of the appendix that is the causative factor, I think this study should give pause to those who believe that appendectomies have no long term detrimental effects.<br />
<br />
We know that the appendix contains a small sampling of the microbiome of the gut. This may well act as a reservoir to replenish microbes in the gut following infection or antibiotic therapy.<br />
<br />
Similar studies have shown a ‘clear relationship’ between removal of the appendix and certain cancers. In holistic health, the appendix is thought to play a pivotal role in the GALT (gut associated lymphoid tissue), the primary immune system of the body.<br />
<br />
<b>Bottom Line:</b><br />
If at all possible, keep your appendix. Some physicians are advocating treatment of appendicitis with antibiotic therapy rather than surgery. Others decry the automatic removal of the appendix whenever any other abdominal surgery is performed.<br />
<br />
Source: May 10, 2019 NIHDr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-9805506917636203162019-05-22T10:30:00.000-04:002019-05-28T16:05:11.685-04:00Wisdom Wednesday: Detox Drinks<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" /></a></div><br />
Some people claim that detox drinks help remove toxins from a person's body and promote weight loss. Typically, a person will include detox drinks as part of a detox diet. However, there is very little evidence that these types of drinks and diet have any detoxification effects. The use of the word detox is not always appropriate. Detox drinks may boost health, aid in weight loss, and support the body's natural detoxification processes, but this is different from medical detoxification.<br />
<br />
An article in the Journal of Human Nutrition and Dietetics notes that some studies show that commercially available detox diets may improve the way a person's liver removes toxins from their body. However, the article also highlights that these studies had flawed methodologies and small sample sizes. A study in the journal Current Gastroenterology Reports found that a detox diet may help a person lose weight, but only because the diet is low in calories. Further, the authors note that diets that help a person lose weight by significantly reducing the number of calories they consume are unsustainable. Typically, people who undertake such calorie-restrictive diets put the weight back in the medium-to-long term.<br />
<br />
The National Center for Integrative and Natural Health (NCINH) point out that as well as causing problems with a person's weight in the mid-to-long term, a person on a detox diet may not be getting the nutrition they require to keep their body healthy. Although they do not detox in the medical sense, detox drinks can be healthful.<br />
<br />
Typically, people use a food processor to turn raw ingredients into a smoothie. As well as being a convenient way to consume fruits and vegetables, using fresh ingredients preserves the fiber in fruits and vegetables, which the juice alone lacks.<br />
<br />
<a name='more'></a><br />
<br />
How healthful a smoothie is will depend on the ingredients. For example, a lemonade cleanse detox drink, containing lemon juice, maple syrup, and cayenne pepper, sounds healthful, but it contains relatively few nutrients and is high in sugar.<br />
<br />
There is little scientific evidence to support claims that detox drinks can help remove toxins from the body. However, a detox drink may be a healthful drink if it contains plenty of fruits, vegetables, nuts, and seeds. A diet rich in fruits, veggies, healthful proteins, fats, and fibrous carbohydrates promotes the natural detoxification system in the body and creates overall balance.<br />
<br />
<b>My Take:</b><br />
The most common request I hear from a new patient is they want to do a liver detox. Many of them are already taking products supposedly designed to create liver detoxification.<br />
<br />
Liver detoxification is possible, although typically not with most of the commercially available products as this article suggests. But is it healthy? The answer is – it depends. Honestly, most patient’s general health is too poor to properly support liver detoxification.<br />
<br />
Evaluation of liver detoxification pathways is step 19 in the QA (Quintessential Applications) protocol. In the eighteen steps that proceed liver detox, inflammation, immune system, citric acid cycle and the endocrine system are all addressed. Then, and only then do we turn our attention to the evaluation and treatment of phase 1 and phase 2 liver detoxification. This provides a strong base to support any treatment protocol.<br />
<br />
<b>Bottom Line:</b><br />
Liver detoxification can be an important step in regaining health. However, you must reduce inflammation and address other health issues prior to successfully implementing any liver detoxification program. I also suggest testing for genetic defects in the methylation pathways as well.<br />
<br />
May 20, 2019 NIH<br />
<br />
Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-2661905986362203782019-05-15T10:30:00.000-04:002019-05-21T14:44:07.773-04:00Wisdom Wednesday: Prescription Drug Use <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" /></a></div><br />
During 2015-2016, about 46% of the US population used one or more prescription drugs in the past 30 days, down slightly from 48% a decade ago, according to new data from the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention.<br />
For the 2015-2016 period, prescription drug use increased with age, from 18% among children younger than 12 years to 85% among adults 60 and older, Cynthia L. Ogden, PhD, and colleagues report in a data brief published online May 8.<br />
<br />
Prescription drug use was lower among males (42%) than females (50%), although the pattern differed by age. Among children up to age 11, prescription drug use was higher among boys (22%) than girls (14%), while among adults aged 20 to 59, prescription drug use was lower among men (38%) than women (56%). There were no significant differences by gender among adolescents aged 12 to 19 or adults aged 60 or over.<br />
<br />
Prescription drug use was highest among non-Hispanic whites (50%), followed by non-Hispanic blacks (45%), and lowest among non-Hispanic Asian (33%) and Hispanic individuals (37%).<br />
<br />
<a name='more'></a><br />
<br />
The most commonly used prescription drugs were bronchodilators for children aged 0 to 11 years (4%), central nervous system stimulants for adolescents aged 12 to 19 (6%), antidepressants for adults aged 20 to 59 (11%), and lipid-lowering drugs for adults aged 60 or over (46%).<br />
Looking at prescription drug use trends over the past decade, the researchers observed an overall decreasing linear trend from 2007-2008 through 2015-2016, from 48% to 46% of the US population, with the most statistically significant trend down among children aged 0 to 11, from 22% to 18%. The authors note, though, that the observed declines in drug use among other age groups were not statistically significant.<br />
<br />
<b>My Take:</b><br />
This mild decrease in prescription drug use is encouraging but must continue and accelerate to effect real change. I am pleased that the decrease is the most significant in children. However, the most commonly used drugs are of great concern – central nervous system stimulates for adolescents, antidepressants for young adults and statins for adults over 60.<br />
<br />
<b>Bottom Line:</b><br />
This country must change its’ perception of prescription drug use as the norm rather than the exception.<br />
<br />
Source: May 8, 2019 NIH Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-64588941595103227702019-04-29T17:17:00.002-04:002019-04-29T17:17:40.609-04:00Bill’s Blog Is On VacationMy wife and I are in Europe celebrating our 25th wedding anniversary. <br />
No internet and no blogs until Wisdom Wednesday, May 15th!Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-49840516953891332742019-04-26T10:30:00.000-04:002019-04-26T10:30:06.497-04:00Researchers look at the link between gut bacteria and autismNew research looks to the gut microbiome to try to address some of the symptoms associated with autism, but this investigation comes with its own set of problems.<br />
<br />
The National Institute of Neurological Disorders and Stroke explain that "autism spectrum disorder (ASD) refers to a group of complex neurodevelopment disorders characterized by repetitive and characteristic patterns of behavior and difficulties with social communication and interaction." They also point out that specialists use the term "spectrum," as autism is different in different individuals. The condition can incorporate a "wide range of symptoms, skills, and levels of disability in functioning." <br />
<br />
Research has also found that autistic children often experience chronic gastrointestinal problems a lot more frequently than children without autism. This has led scientists from Arizona State University in Tempe to explore whether a fairly new form of therapy — microbiota transfer therapy (MTT) — can help solve gastrointestinal issues in autistic children. Also, they wanted to see whether this intervention could affect other autism markers. MTT involves collecting, processing, and freezing the fecal material of healthy people, and then administering it — orally or rectally — to the person receiving the treatment. Thus, the healthy bacteria should re-establish a balance in the gut microbiome of the person experiencing gastrointestinal problems.<br />
<br />
The researchers explain that at the start of the study, autistic children had poorer bacterial diversity in the gut, compared with neurotypical children with healthy and balanced microbiota. More specifically, two beneficial bacterial strands — Bifidobacteria and Prevotella — were lacking in the microbiota of children on the spectrum. Following the initial MTT intervention, the autistic children experienced more gut bacterial diversity, including increased levels of Bifidobacteria and Prevotella. In the new clinical trial, which measured bacterial diversity in the gut after 2 years from the intervention, the children had even more bacterial diversity and a steady presence of healthful bacteria.<br />
<br />
<a name='more'></a><br />
<br />
As for the health effects, the children saw a 58 percent decline in symptoms tied to gastrointestinal problems. Also, the authors write that the children involved in this study showed "a slow but steady improvement in core ASD symptoms," with a 45 percent improvement in measurements related to language, social interaction, and behavior. According to Dr. Thomas Borody, the gastroenterologist who pioneered MTT, "This is a world first discovery that when we treated the gut bacteria in these children during our clinical trial 2 years ago to reset their microbiome with [fecal microbiota transplant], positive results are still continuing to be improving 2 years from the original treatments." "I," adds Dr. Borody, "would call it the highest improvement in a cohort that anyone has achieved for autism symptoms."<br />
<br />
<b>My Take:</b><br />
This study has been criticized for several reasons. The study was small with only 18 participants and was funded by a company that provides fecal microbiota transplant therapy. While I agree with those criticisms, the connection between the gut microbiota and autism spectrum is well worth further investigation.<br />
<br />
Add this study to several others that have expanded the concept of the HPA (hypothalamus pituitary adrenal) axis to the new title HPA gut axis. Gut microbes have an intimate relationship with the brain and endocrine system of our body.<br />
<br />
<b>Bottom Line:</b><br />
If a child is not born through vaginal delivery, the lack of that initial inoculation with the mother’s microbes can never be replaced. However, there are several techniques now available to help mitigate this loss. Clinically, I begin with oral Lactobacillus bulgaris supplementation, but vaginal smear and now fecal implant are viable options.<br />
<br />
Source: April 11, 2019 NIH Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-48092437657908414302019-04-24T10:30:00.000-04:002019-04-24T10:30:07.939-04:00Thyroidectomy Seems to Improve Quality of Life in Hashimoto Disease<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" /></a></div><br />
Total thyroidectomy appears to improve quality of life in patients with Hashimoto disease, according to a study in the Annals of Internal Medicine.<br />
<br />
Roughly 150 adults with Hashimoto-related symptoms despite adequate hormone substitution were randomized to receive either total thyroidectomy with standard medical therapy or medical therapy alone. All had serum antithyroid peroxidase (anti-TPO) antibody titers above 1000 IU/mL at baseline.<br />
<br />
At 18 months, surgery patients had significantly better health-related quality-of-life scores than did controls. Surgery patients also had improved fatigue scores, and their serum anti-TPO antibody levels were significantly lower.<br />
<br />
<b>My Take:</b><br />
Hashimoto’s disease is an autoimmune disease of the thyroid gland. It is estimated that a third of all patients suffering from hypothyroidism have Hashimoto’s.<br />
<br />
The condition often goes undiagnosed as the confirmatory tests – thyroid peroxidase and thyroid autoantibodies – are seldom performed. However, there is renewed interest in Hashimoto’s as evidenced by this study.<br />
<br />
Traditional treatment of Hashimoto’s disease is limited to hormone replacement therapy using Synthroid. There is no medical approach to treat the underlying autoimmune disease. Even in this extreme treatment where the thyroid gland is surgically removed, the underlying disease is not addressed.<br />
<br />
<a name='more'></a><br />
<br />
Autoimmune disease is progressive in nature. Although the errant immune system may initially target the thyroid gland, over time other tissues of the body are affected.<br />
<br />
To complicate matters, the lab tests can be transient. I have a patient that was tested every three months for three years before her lab tests confirmed her diagnosis of Hashimoto’s disease.<br />
<br />
Autoimmune disease is triggered by a foreign substance in the blood stream. Low grade viral infections, especially EBV (Epstein-Barr virus) have been implicated as the trigger in a third of patients with Hashimoto’s, MS or RA. However, any protein complex consisting of five or more amino acids will precipitate an immune response. The same is true of any sugar larger than a monosaccharide. So, food particles that are not fully digested are also suspect.<br />
<br />
Increased intestinal permeability (leaky gut) is the predisposing factor allowing these larger chemical compounds to enter the blood stream. Once identified, the immune system attacks these compounds. As the immune system targets this sequence of amino acids or sugars, it looks and finds this pattern in our tissues as well and the self-attack begins. The disease is named for the initial tissue under siege but the process is the same.<br />
<br />
<b>Bottom Line:</b><br />
While patients with Hashimoto’s thyroiditis may show some improvement in symptoms following thyroidectomy, surgery is not the answer. Treat the underlying autoimmune disease – modulate the immune system and repair the leaky gut.<br />
<br />
Source: March 12, 2019 New England Journal of Medicine<br />
<br />
Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-20375722902374362602019-04-22T10:30:00.000-04:002019-04-22T15:03:05.750-04:00Review: The Role of Vitamin D and Lipoprotein Receptor-Related Protein in Amyloid Clearance and Brain HealthA review on the relationship between vitamin D and low-density lipoprotein receptor-related protein (LRP-1) has revealed that the two may work together to possibly clear amyloid-beta (Aβ), whose deposition is considered linked to the progression of neurological dysfunction.<br />
<br />
LRP-1 is a large receptor present on the body’s cells and is widely expressed, or present in several tissues. It’s a member of the LDL receptor family, which plays various different roles related to enzyme activation, the entry of bacterial toxins and viruses into cells and the metabolism of proteins that transport and combine with fats in the blood.<br />
<br />
But LRP-1 has also been identified as a Aβ scavenger receptor that can remove Aβ from the brain through the blood-brain barrier. However, its expression is decreased in patients with neurological dysfunction.<br />
<br />
This review points to recent evidence that after supplementation with the active form of vitamin D, 1,25 (OH)2D3, LRP1 expression increases significantly both in-vivo and in-vitro. This is because so many vitamin D receptors are expressed in the brain.<br />
<br />
<a name='more'></a><br />
<br />
Several studies also suggest that vitamin D receptor (VDR, the receptor to which vitamin D binds to in the body) deficiency, or inhibition, could be a risk factor for neurodegenerative disease. This review establishes a strong connection between vitamin D, LRP-1, and their potential Aβ clearance abilities.<br />
<br />
<b>My Take:</b><br />
By neurological dysfunction, they mean Alzheimer’s disease. To review my previous blogs on this subject just type in “Alzheimer’s” in the search box in the upper left hand corner of my blog site. The formation of clusters of amyloid-beta plaque is a classic finding in Alzheimer’s disease. Previous studies have linked the uncoupling of copper by toxins and infection to the formation of these clusters. This study suggests that vitamin D plays a vital role in removing these triggers from the brain.<br />
<br />
The active form of vitamin D is not what is typically measured in laboratory testing. That is because the levels in the blood fluctuate by the minute. What we typically measure is the inactive form 25 (OH)D3. However, there is good correlation with the inactive form in the blood and the active form in the tissues.<br />
<br />
Some of us make the precursor to the inactive form when sunlight strikes the skin and converts cholesterol into D3. It is then transported to the liver to be converted to 25 (OH)D3. In turn, the inactive form is converted to the active form by the kidneys or by individual cells. Making vitamin D from sunlight is dependent on the vitamin D receptor (VDR receptor). Approximately 25% of the population has a defect in the VDR gene from one parent, limiting their ability to convert vitamin D from cholesterol. Eight percent of the population has the defect from both parents and cannot make the conversion.<br />
<br />
<b>Bottom Line:</b><br />
More evidence of the need to supplement vitamin D. I recommend supplementation of vitamin D3 at 4,000 IU daily with laboratory testing at least annually. The laboratory norms are 30-100 ng/mL but the optimal range is 42-80 ng/mL.<br />
<br />
Source: April 18, 2019 Biotics Research<br />
<br />
Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-72636149381297463322019-04-19T10:30:00.000-04:002019-04-22T15:00:56.856-04:00Is it better to get nutrients from food or supplements?Researchers have found that nutrients from food may be linked to lower risks of death, while excess intake of certain supplements may have the opposite effect.<br />
<br />
Taking supplements leads to an increased level of total nutrient intake. Dietary supplements include vitamins, minerals, herbs, amino acids, and enzymes. Suppliers sell them in different forms, including tablets, capsules, powders, and liquids. Common dietary supplements include calcium, fish oil, and vitamin D. <br />
<br />
According to the 2018 consumer survey conducted by the Council for Responsible Nutrition (CRN), consumer confidence in products and trust in the dietary supplement industry is strong among people in the U.S. The survey found that 75 percent of U.S. individuals take dietary supplements, as opposed to just 65 percent in 2009. "This year's data provide further evidence that dietary supplements are mainstays in modern day health and wellness regimens," explains Brian Wommack, the senior vice president of communications at the CRN. Vitamin and mineral supplements such as vitamin D and calcium remain the most popular types. However, the use of herbals and botanicals — especially turmeric — has significantly increased during the past 5 years.<br />
<br />
The main reason that U.S. individuals take dietary supplements is overall health and wellness, according to the survey. Although many people use dietary supplements, a recent study found that multivitamins, vitamin D, calcium, and vitamin C showed no advantage or added risk in the prevention of cardiovascular disease or premature death. However, folic acid alone and B vitamins with folic acid may reduce the risk of heart disease. The team, from the Friedman School of Nutrition Science and Policy at Tufts University in Medford, MA, conducted a study to evaluate the association between dietary supplement use and all-cause mortality. The researchers have published their results in the journal Annals of Internal Medicine.<br />
<br />
<a name='more'></a><br />
<br />
For each nutrient, the scientists calculated the daily supplement dose by combining the frequency with the product information for ingredient, the amount of ingredient per serving, and ingredient unit. They assessed the participants' dietary intake of nutrients from foods using 24-hour dietary recalls and mortality outcomes through the National Death Index through December 31, 2011.<br />
<br />
Adequate intakes of vitamin A, K, zinc, and magnesium — from food, not supplements — were linked to a lower risk of death. Adequate intakes of vitamin A, vitamin K, and zinc — from foods, not supplements — were associated with a lower risk of death from cardiovascular disease. Excess intake of calcium was associated with a higher risk of dying from cancer. Excess intake of calcium from supplements (at least 1,000 milligrams per day) was associated with an increased risk of death from cancer.<br />
<br />
In addition to the harmful effects of excess calcium intake from supplements, the researchers found that people with no sign of vitamin D deficiency who use vitamin D supplements may have an increased risk of all-cause mortality. Further research on this potential connection is necessary.<br />
<br />
Our results support the idea that, while supplement use contributes to an increased level of total nutrient intake, there are beneficial associations with nutrients from foods that aren't seen with supplements."<br />
<br />
<b>My Take:</b><br />
The article also notes some limitations in the study, including the duration of dietary supplement use studied and the fact that dietary supplement use was subject to recall bias. I agree that getting your nutrition from food is ideal and that the synergistic effects of all the nutrients in food surpasses the benefit of supplementation. However, this is a poorly designed study and no conclusions should be drawn for the outcome.<br />
<br />
Supplementation is not a replacement for a good diet. As the name implies, it is a “supplement” to the diet. Few, if any of us, are getting enough omega-3 fatty acids in our diet. When 95% of the U.S. population is deficient in vitamin D do you have to exhibit symptoms of vitamin D deficiency to understand the need for supplementation?<br />
<br />
Standard Process, one of my main supplement providers, shares this whole food philosophy. All their products are made from organically grown whole food. I prefer to use this product line whenever possible. However, some deficiencies, like genetic impairment of folic acid or vitamin B12 methylation, require the use of bioavailable supplements not derived from whole food.<br />
<br />
<b>Bottom Line:</b><br />
Our food quality and SAD (standard American diet), require supplementation to meet the needs of the human body. This study appears to be contrived to undermine this simple fact.<br />
<br />
Source: April 12, 2019 NIHDr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-15809519427658961482019-04-17T10:30:00.000-04:002019-04-22T14:59:48.363-04:00Wisdom Wednesday: Mineral Water versus Tap Water<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" /></a></div><br />
Mineral water comes from underground reservoirs. Unlike regular drinking water, mineral water does not undergo chemical processing. As the name suggests, mineral water contains high quantities of minerals, especially magnesium, calcium, and sodium. But is mineral water better than regular water, and what are its benefits?<br />
<br />
This article discusses some possible health benefits associated with drinking mineral water.<br />
<br />
All living organisms need water to survive. Not only does water support essential physical functions, it also provides vital nutrients that the body does not produce on its own. While most people in the United States have access to clean drinking water, many people choose bottled mineral water for its perceived purity and potential health benefits.<br />
How does mineral water compare with regular water? Based on the current evidence, the differences are not very significant. The water in household taps comes either from surface or underground sources.<br />
<br />
In the U.S., tap water must meet the Safe Drinking Water Act standards established by the<br />
Environmental Protection Agency (EPA). These regulations limit the number of contaminants present in water supplied to homes. Public water suppliers move water from its source to treatment plants, where it undergoes chemical disinfection. The clean water ultimately gets delivered to households through a system of underground pipes.<br />
<br />
<a name='more'></a><br />
<br />
Tap water contains added minerals, including calcium, magnesium, and potassium. Hard tap water has higher mineral contents, which some consider more healthful. However, minerals in hard water form deposits that can corrode pipes or restrict the flow. Also, despite the efforts of public water suppliers, contaminants from rusted or leaking pipes can pollute drinking water.<br />
<br />
Mineral water comes from natural underground reservoirs and mineral springs, giving it a higher mineral content than tap water. According to the Food and Drug Administration (FDA), mineral water must contain at least 250 parts per million of total dissolved solids. The FDA prohibit these manufacturers from adding minerals to their products.<br />
<br />
Minerals that are often present in mineral water include: calcium, magnesium, potassium, sodium, bicarbonate, iron and zinc. Unlike tap water, mineral water is bottled at the source. Some people prefer mineral water due to its perceived purity and the lack of chemical disinfection treatments. However, mineral water may undergo some processing. This can include adding or removing carbon dioxide (CO2) gas or eliminating toxic substances, such as arsenic. CO2 helps prevent oxidation and limits bacterial growth in mineral water. Naturally carbonated water gets its CO2 from the source. Manufacturers can also infuse their water with<br />
CO2 after extraction.<br />
<br />
Studies suggest that drinking mineral water may have health benefits, though little research directly suggests that it is better for a person's health than tap water. People who want to buy mineral water can find it in supermarkets or choose from brands online. Also, in the U.S., the EPA strictly regulates tap water quality to ensure that it is free from harmful microbes. Tap water also contains added minerals, making it a cheaper alternative to mineral water.<br />
Drinking carbonated mineral water may cause some tooth erosion, but not to the same extent.<br />
<br />
<b>My Take:</b><br />
This was a nine pages article that you can read in full a Medline. The article goes on to discuss the potential benefits of the five common minerals found in mineral water. What the article doesn’t discuss is that all these mineral in both tap water and mineral water are inorganic. Yes, the body can use these minerals if it can bind them organically. That is not an easy task.<br />
<br />
I recommend getting your minerals from food, not water. All minerals in food are already organically bound and ready for the body to use. Imagine eating your car keys. Your body can leach a little of the iron out of those keys, but not very much. Now imagine burying those keys in your garden and growing spinach in the soil. Over time, the keys will begin to break down, the spinach will absorb the iron and organically bind it into the leaf. When you eat the leaf you get the benefit of an iron rich plant.<br />
<br />
<b>Bottom Line:</b><br />
Drink distilled water, it’s clean, but also void of minerals. Eat food for your mineral intake and supplement as needed.<br />
<br />
Source: April 9, 2019 NIHDr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-32215468855075937452019-04-15T10:30:00.000-04:002019-04-16T13:54:58.430-04:00How to Understand Your Lab ResultsA laboratory (lab) test is a procedure in which a health care provider takes a sample of your blood, urine, other bodily fluid, or body tissue to get information about your health. Some lab tests are used to help diagnose, screen, or monitor a specific disease or condition. Other tests provide more general information about your organs and body systems. Lab tests play an important role in your health care. But they don't provide a complete picture of your health. Your provider will likely include a physical exam, health history, and other tests and procedures to help guide diagnosis and treatment decisions.<br />
<br />
Lab tests are used in many different ways. Your health care provider may order one or more lab tests to: <br />
Diagnose or rule out a specific disease or condition <br />
<br />
Screen - A screening test can show if you are at a higher risk for getting a specific disease. It can also find out if you have a disease, even if you have no symptoms.<br />
<br />
Monitor a disease and/or treatment - If you've already been diagnosed with a disease, lab tests can show if your condition is getting better or worse. It can also show if your treatment is working.<br />
Check your overall health - Lab tests are often included in a routine checkup.<br />
<br />
Lab results are often shown as a set of numbers known as a reference range. A reference range may also be called "normal values." You may see something like this on your results: "normal: 77-99mg/dL". Reference ranges are based on the normal test results of a large group of healthy people. The range helps show what a typical normal result looks like. But not everyone is typical. Sometimes, healthy people get results outside the reference range, while people with health problems can have results in the normal range. If your results fall outside the reference range, or if you have symptoms despite a normal result, you will likely need more testing. Your lab results may also include one of these terms:<br />
<ul><li>Negative or normal, which means the disease or substance being tested was not found</li>
<li>Positive or abnormal, which means the disease or substance was found</li>
<li>Inconclusive or uncertain, which means there wasn't enough information in the results to diagnose or rule out a disease. If you get an inconclusive result, you will probably get more tests. Tests that measure various organs and systems often give results as reference ranges, while tests that diagnose or rule out diseases often use the terms listed above.</li>
</ul><br />
<a name='more'></a><br />
<br />
If you have any questions about your lab tests or what your results mean, talk to your health care provider.<br />
<br />
<b>My Take:</b><br />
There are two ranges that I use in my practice – the reference range noted above and the optimal range, which is generally much tighter. The optimal range helps predict disease earlier and is needed as the “large group of healthy people” used for reference is less and less healthy. Additionally, some reference ranges are skewed. For example the reference range for total cholesterol is too strict, while the range for TSH (thyroid stimulating hormone) is too broad.<br />
<br />
Blood chemistry testing is the best screening tool for any new patient. It is the best way to determine several nutritional deficiencies and health issues. It also serves as an objective tool to determine success or failure with nutritional protocols.<br />
<br />
<b>Bottom Line:</b><br />
I am an advocate of yearly blood chemistry testing for all the reasons noted above. As a minimum, I recommend a CBC, comprehensive metabolic profile, lipid panel, magnesium, T3, T4, TSH and urine analysis. However, I typically add a hemoglobin A1c, homocysteine, hs-CRP, insulin, and vitamin D to throw a broader net for aspects of metabolic syndrome.<br />
<br />
Source: April 15, 2019 NIH<br />
Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-22375828267915802922019-04-10T10:30:00.000-04:002019-04-11T14:52:32.081-04:00Wisdom Wednesday: Metformin for Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" /></a></div><br />
Clinical Question<br />
How effective is metformin in the treatment of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis?<br />
<br />
Evidence-based Answer<br />
Metformin does not seem to be an effective treatment for nonalcoholic steatohepatitis. There are no studies evaluating whether metformin improves long-term patient-oriented outcomes such as progression from NAFLD to nonalcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma, or death from liver failure. Metformin does not improve anatomic outcomes (histologic or ultrasound features of the liver) or biochemical outcomes (alanine transaminase [ALT] and aspartate transaminase [AST] levels, or insulin resistance) in adults. Metformin does not improve liver histologic or biochemical outcomes, or body mass index (BMI) in adults with nonalcoholic steatohepatitis. (Strength of Recommendation: C, based on a meta-analysis of randomized, controlled trials [RCTs] evaluating laboratory parameters.) Similarly, metformin does not improve histologic or biochemical outcomes, or BMI in children and adolescents with NAFLD. (Strength of Recommendation: C, based on RCTs evaluating laboratory parameters.)<br />
<br />
Evidence Summary<br />
Adults With NAFLD<br />
No studies have evaluated patient-oriented outcomes of metformin therapy for NAFLD or nonalcoholic steatohepatitis. An RCT found no improvement in liver histology on biopsy.[1,2] Two placebo-controlled RCTs (N = 113) evaluating the effect of metformin (850 to 1,700 mg per day) on ALT and AST levels, insulin resistance, and BMI found no differences. One RCT (n = 48) found a small decrease in BMI. Another RCT (n = 2,153) found no improvement in ALT levels after treatment with metformin (850 mg twice per day) vs. placebo.[2]<br />
<br />
Adults With Nonalcoholic Steatohepatitis<br />
Two RCTs (N = 52) evaluating metformin (500 to 1,000 mg per day) in patients with nonalcoholic steatohepatitis found that it did not improve liver histology, ALT and AST levels, BMI, or insulin resistance.[1,3]<br />
<br />
Children With NAFLD<br />
Two RCTs (N = 172) evaluating metformin (1,000 to 1,500 mg per day) vs. placebo in children with obesity and NAFLD found no improvement in liver histology on biopsy, ALT and AST levels, BMI, or insulin resistance.[4,5] A smaller RCT (n = 50; mean age: 15 years) found that metformin (850 mg twice per day) improved ultrasound scores for fatty liver but did not improve ALT and AST levels.[6]<br />
<br />
Recommendations From Others<br />
An evidence-based guideline from the American Association for the Study of Liver Diseases, the American College of Gastroenterology, and the American Gastroenterological Association states that metformin has no significant effect on liver histology and is not recommended as a treatment for liver disease in adults with nonalcoholic steatohepatitis.[7]<br />
<br />
<a name='more'></a><br />
<br />
<b>My Take:</b><br />
I am showing you the full abstract (minus the references) to give you a sense of what these studies look like.<br />
<br />
Metformin is commonly used to treat type II diabetes. It works by preventing the liver from releasing glycogen (stored glucose) from the liver when cortisol is released from the adrenal glands. In normal physiology, cortisol is released in response to dropping blood sugar levels. The release of glycogen raises glucose levels back to the normal range. This is a vital hormonal response when we are sleeping and unable to eat, fasting (intermittent or otherwise) and in response to stress.<br />
<br />
Off label use of metformin for PCOS (polycystic ovarian syndrome), NASH and NAFLD has been practiced for more than 20 years. This study questions the valve of such off label use.<br />
Physicians are allowed to use a drug for purposes other than those for which the drug has been tested (off label use) if their clinical experience indicates it has value. Remember that evidenced-based research only accounts for one-third of the criteria for clinical decision making. Clinical experience and patient preference are the other two-thirds. However, one can’t help but question the clinical experience that led to this off label use.<br />
<br />
<b>Bottom Line:</b><br />
Currently, no conventional medical treatment is available for NASH or NAFLD so I can see how physicians turned to metformin. However, Silymarin, the active target compound in Milk Thistle has been shown to be effective in the treatment of both of these liver diseases. Clinically, I have also found combining Silymarin with lecithin (phosphatidylcholine) enhances this benefit.<br />
<br />
Source: Am Fam Physician. 2019;99(4):262-263Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-43312484054564284622019-04-08T13:34:00.004-04:002019-04-08T13:34:51.359-04:00How Sugary Drinks Fuel CancerResearchers acknowledge that obesity increases the risk of cancer, and some studies even consider the existence of a causal relationship between this metabolic condition and cancer.<br />
<br />
One important factor that can lead to obesity is the high intake of sugar through the frequent consumption of processed foods and sugary beverages. However, so far, there has been limited research looking at the effects of sugar on tumor growth independently of obesity.<br />
Now, a team of specialists from Baylor College of Medicine in Houston, TX and Weill Cornell Medicine in New York City, NY has collaborated with colleagues from other research institutions to identify a clear link between sugary drinks and the accelerated growth of tumors in colorectal cancer.<br />
<br />
In the new study, the results of which appeared yesterday in the journal Science, the research team studied the effects of high-fructose corn syrup in mouse models of colorectal cancer.<br />
<br />
The team opted for a solution of 25-percent high-fructose corn syrup because this is the type of sweetener that manufacturers most commonly used as an ingredient in popular soft drinks.<br />
<br />
"The current thought is that sugar is harmful to our health mainly because consuming too much can lead to obesity," explains co-author Jihye Yun, who is an assistant professor of molecular and human genetics at Baylor College of Medicine. "We know that obesity increases the risk of many types of cancer, including colorectal cancer; however, we were uncertain whether a direct and causal link existed between sugar consumption and cancer."<br />
<br />
The team conducted the research in mice with early-stage colorectal cancer in which they deleted a gene called "Apc." This gene encodes a protein with the same name, and its deletion simulated a mutation that characterizes fast-growing colon cancer in humans. "More than 90 percent of colorectal cancer patients have this type of Apc mutation," the researcher points out.<br />
<br />
In the first stage of the study, the researchers allowed the mice to drink the sugary beverage freely. As a result, the rodents put on a lot of weight within just 1 month.<br />
<br />
To determine whether or not the corn syrup would boost cancer growth independently of obesity, the team then decided to administer the sugary drink in a way that would allow the mice to ingest it without putting on weight. So, the researchers gave the mice the sugary drink orally through a specially designed syringe once a day for 2 months.<br />
<br />
Following this 2-month intervention, the investigators observed that the rodents had not put on too much weight, but they had indeed developed larger, more advanced tumors than the rodents who had only received water.<br />
<br />
<a name='more'></a><br />
<br />
"These results suggest that when the animals have early stage of tumors in the intestines — which can occur in many young adult humans by chance and without notice — consuming even modest amounts of high-fructose corn syrup in liquid form can boost tumor growth and progression independently of obesity," Yun points out.<br />
<br />
"Further research is needed to translate these discovery to people," she admits, though she goes on to add that, "however, our findings in animal models suggest that chronic consumption of sugary drinks can shorten the time it takes cancer to develop."<br />
<br />
"In humans, it usually takes 20 to 30 years for colorectal cancer to grow from early-stage benign tumors to aggressive cancers," says Yun.<br />
<br />
<b>My Take:</b><br />
This is quite a long article and I reduced it by more than 50%. It goes on to document how fructose enables glucose to be used by cancer cells to ramp up fatty acid metabolism. Sugary drinks typically contain roughly equal parts of both fructose and glucose. However, only glucose is essential for the human body. Thus, the elimination of fructose may be a viable preventive measure for colon cancer.<br />
<br />
<b>Bottom Line:</b><br />
Sugary drinks are not only bad for you because they promote obesity. They also contain the one-two punch of fructose and glucose that feeds colon cancer. Please eliminate these products from your diet.<br />
<br />
Source: March 23, 2019 NIH <br />
<br />
Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-29141022402067065632019-04-03T10:30:00.000-04:002019-04-08T13:32:47.354-04:00Wisdom Wednesday: Continuing ARB Recalls Shake Up Hypertension, HF Care<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpuunAaaOBijkzb5__tLqU7_Qw9lMK9H5xpknhYgK9aCzR7XERhOLy1sQaD7LyRSUHg7gBXPgVGdokrLpE-lnTA9TGUlo74V81o1CV8p_tmGYmyC6vVTfpValqhDW_XTkDh0OI2naaxOM/s1600/WisdomWednesday.jpg" /></a></div><br />
Concerns over ongoing recalls of angiotensin II receptor blockers (ARBs) are forcing physicians and patients to choose between optimal treatments and rattling confidence in the safety of the generic drug supply itself.<br />
<br />
"I see hypertension on a regular basis and on any given clinic day, four to five patients have either stopped their medicines or have considered stopping their medicines and a separate detailed conversation has to be put in place to try to convince them to continue," Keith Ferdinand, MD, Tulane University Heart and Vascular Institute, New Orleans, told theheart.org | Medscape Cardiology.<br />
<br />
ARBs are recommended for the treatment of hypertension, heart failure, and chronic kidney disease, with more than 61 million prescriptions written for valsartan, losartan, and irbesartin in the United States in 2016, according to the federal ClinCalc DrugStats database.<br />
<br />
Ongoing US Food and Drug Administration (FDA) recalls — all in generic ARB-containing products — began last July when the probable carcinogen N-nitrosodimethylamine (NDMA) was detected in the valsartan active pharmaceutical ingredient (API) supplied by Zhejiang Huahai Pharmaceuticals (ZHP), Linhai, China.<br />
<br />
Within months, the rolling recalls had extended to irbesartan- and losartan-containing products. A second probable carcinogen, N-nitrosodiethylamine (NDEA), was identified last fall and a third, N-nitroso-N-methyl-4-aminobutyric acid (NMBA), only last month.<br />
<br />
<a name='more'></a><br />
<br />
George Bakris, MD, director of the hypertension unit, University of Chicago, said his patients are aware of the cancer risk but haven't stopped taking medications. Initially he advised them to remain on valsartan if insurance wouldn't pay for an alternative ARB and the pharmacy could verify the drug was not made in China. Nevertheless, more than 85% switched.<br />
<br />
<b>My Take:</b><br />
Angiotensin II receptor blockers (ARBs) have replaced ACE inhibitors, beta blockers and calcium channel blockers as preferred drugs in the treatment of hypertension, heart failure, and chronic kidney disease. Please type “hypertension” into the search box in the upper left hand corner of my blog site to see my previous posts on this subject.<br />
<br />
Medication for hypertension is typically how most patients start down the path to polypharmacy. I believe that congestive heart failure is often the result of taking these medications long term.<br />
<br />
The tone of this article suggests patients should just take the drugs and not worry about the risk of cancer. What an inconvenience for the physician to have a separate detailed conversation to try to convince them to continue. Apparently, these conversations are not very effective as another doctor reports 85% of patients subsequently switched.<br />
<br />
<b>Bottom Line:</b><br />
Lifestyle changes can prevent or reverse hypertension, even after the introduction of medication. Weight loss, regular exercise, even naps have been shown to reduce hypertension as effectively as these drugs.<br />
<br />
Source: March 28, 2019 NIH Dr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0tag:blogger.com,1999:blog-4645738430700126858.post-65238024532415324662019-04-01T10:30:00.000-04:002019-04-01T14:19:50.600-04:00When to Consume ProteinWe all need protein as part of a balanced diet and to stay healthy. Some people consume protein for specific reasons, such as to help them lose weight or gain muscle mass. However, it is not yet clear when the best time is to have that protein. There is some evidence that consuming protein can help a person lose weight, and there is clear evidence that it can help people build muscle mass if they also exercise. However, research, as yet, does not make it unclear when is the best time to have protein. It is also unclear if there is any best time at all, why this is the case, or whether it is the case for everyone.<br />
<br />
Most people in the United States get enough protein in their diet. Still, the United States Department of Agriculture (USDA) say many people should vary the types of food containing protein that they eat. If a person is trying to build muscle mass, they may also take protein in the form of supplements to help them build muscle tissue after exercise.<br />
<br />
There is some evidence that eating protein can help a person lose weight. Evidence suggests protein does this in part by increasing satiety. Satiety is the feeling of being full. Currently, there is little solid evidence regarding when the best time to eat protein might be to encourage weight loss. For example, researchers published a study in the journal Advances in Nutrition suggesting that eating snacks that contain protein may reduce the number of calories a person consumes at their next meal. However, the research paper also points out that studies demonstrating this are scarce and sometimes conflicting. They suggest more studies are needed to confirm their findings. <br />
<br />
<a name='more'></a><br />
<br />
Various studies have looked at whether there is a link between the time a person consumes protein and hypertrophy, which is how much muscle a person builds after exercise. However, the results are unclear. More research is necessary to establish if there is a link between the timing of protein intake and the amount of muscle a person builds. The researchers conclude that there are no known downsides to eating protein before or after a workout. Also, if that helps an athlete get sufficient nutrients for their body to recover, then there is no issue.<br />
<br />
<b>My Take:</b><br />
The original article sited lots of studies with little or no conclusions. One of the older studies cited recommended eating protein within 30 minutes of vigorous exercise. I have followed this recommendation for years.<br />
<br />
Eating during exercise was not covered. During long periods of exercise, like long distance cycling or running, it is vital to replace calories as well as water and electrolytes. I recommend eating if your exercise lasts more than an hour. Protein bars can easily be carried and consumed with little effort. We always carry them on our bikes, along with some carbohydrate source, like goo, to replenish fuel for the body.<br />
<br />
<b>Bottom line:</b><br />
To date, there is no “best practice” for consuming protein. Try some of these recommendations and see if they work for you. Adequate protein intake is easy for most of us. Those on a plant-based diet must work harder to ensure they get at least 45 g of protein daily.<br />
<br />
Source: March 25, 2019 NIHDr. Longstrethhttp://www.blogger.com/profile/05925248156818463833noreply@blogger.com0