Friday, May 27, 2016

Loss of Y Chromosome in Men Tied to Alzheimer’s Risk

Men who lose Y chromosomes from their blood cells as they age may have an increased risk of developing Alzheimer’s disease, a new study suggests.

The study of more than 3,200 men found those who already had Alzheimer’s were nearly three times more likely to show a loss of the Y chromosome in some of the blood cells. What’s more, older men with that “loss of Y” faced a higher risk of developing Alzheimer’s over the next eight years.

Experts said the study doesn’t prove that loss of the Y chromosome directly contributes to Alzheimer’s disease. But it adds to evidence tying loss of the Y to disease risk, said study co-author Lars Forsberg.

It also raises the possibility of one day testing men’s blood for loss of Y, to predict their risk of developing Alzheimer’s, said Forsberg, a researcher at Uppsala University in Sweden.

The findings were reported online May 23 in the American Journal of Human Genetics.

Men have an X and a Y chromosome, while women have two X chromosomes. Researchers used to think that the Y did little more than determine male sex and ensure normal sperm production.

But recent studies have shown that the Y chromosome contains a large number of genes, whose jobs are not fully understood yet.

Similarly, researchers have long known that as men age, they can lose the Y chromosome form some of their body cells. It was seen as a normal part of aging. Some recent studies, however, have suggested otherwise.

Wednesday, May 25, 2016

Wisdom Wednesday: Psoriasis

Psoriasis is characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plagues covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp but it can also affect the torso, palms, and soles of the feet.

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. Just imagine the joints going through the same chemical inflammation as the skin. The National Psoriasis Foundation estimates that between 10 to 30% of people with psoriasis also have psoriatic arthritis. Clinically, I find that number is closer to 30%.

I am of the opinion that psoriasis is an auto-immune disease and recent research indicates some abnormality in the immune is the key to the cause of psoriasis. Episodes can be triggered by emotional stress, trauma, and infection.

Injured skin and certain drugs can aggravate psoriasis, including some blood pressure medication (like beta-blockers), the anti-malarial medication hydroxychloroquine, and ibuprofen (Advil, Motrin, etc.)

Psoriasis tends to run in families, but it may skip generations.

I have used fish oil, an omega 3 fatty acid to treat psoriasis for over 30 years. It typically reduces the ugly red plague by 80-90% in a couple of weeks. I started using it long before I understood the prostaglandin inflammatory pathways that omega 3 fatty acids inhibit. I had been using fish oil to reduce LDL cholesterol and total cholesterol (back in the days when I thought that had value) when a few of my patients with psoriasis commented on their improvement. So the use was initially antidotal but later backed up by biochemistry.

Today we evaluate the prostaglandin, leukotriene and cytokine pathways to see what supplements will be most effective with patients suffering from psoriasis. Sometimes black current seed oil, sesame seed oil, ginger or Boswellia are more effective that fish or flax seed oil.

Monday, May 23, 2016

Pesticides Linked to Raised Risk of ALS

Exposure to pesticides and other chemicals may increase the risk for ALS (amyotrophic lateral sclerosis), a fatal neurological disease.

Three toxins in particular were associated with greater risk for the progressive condition, often called Lou Gehrig’s disease because it killed the legendary baseball player.

“We are identifying these toxic, persistent, environmental pollutants in higher amounts in ALS patients compared to those who do not have ALS,” said study co-author Dr. Stephen Goutman. He is assistant professor of neurology at the University of Michigan and director of its ALS Clinic.

The new study doesn’t prove pesticides cause ALS, but it does build on an association suggested in previous research, Goutman said. Scientists already suspect pesticides may contribute to Parkinson’s disease, another neurodegenerative disorder.

For this study, Goutman and his colleagues evaluated 156 patients with ALS and 128 without the disease. Participants were asked about occupational and residential exposure to environmental toxins. Blood samples were taken to measure pesticide levels.

The researchers looked at 122 environmental chemicals and pesticides. Three in particular were linked to heightened ALS risk, Goutman said.

Friday, May 20, 2016

FDA to Re-examine What Makes a Food ‘Healthy’

Which of these foods, if any, should be labeled “healthy”? Raisin bran? Avocados? Granola Bars?
Going by current – and perhaps outdated – U.S. food-labeling regulations, it’s impossible to know, food makers and legislators contend. But that’s about to change under a U.S. Food and Drug Administration plan to redefine the definition of “healthy” foods.

“We believe now is an opportune time to reevaluate regulations concerning nutrient content claims, generally, including the term ‘healthy,’” the FDA said in a statement to the Wall Street Journal.

The process could take years, and will likely rely on public input. A bill in Congress, if approved, would urge the FDA to make this matter a priority, according to the news report.

The nutritional landscape and knowledge of what constitutes a healthy diet has changed considerably since 1994, when the FDA first officially used the term “healthy.” Back then, health advocates were taking aim at fats – not sugar or gluten – which are among today’s targets.

By those old standards, sugary cereals like raisin bran might be considered a healthier option than an avocado, which contains “good” monounsaturated fat.

Among food makers urging a reevaluation of “healthy” is Kind LLC, a producer of granola bars, which was warned by the FDA last year to stop labeling its bars as “healthy” because of fat content, the Journal reported.

“We very much hope the FDA will change the definition of healthy, so that you don’t end up in a silly situation where a toaster pastry or sugary cereal can be considered healthy and a piece of salmon or bunch of almonds cannot,” Kind’s Chief Executive Daniel Lubetzky told the newspaper.

Wednesday, May 18, 2016

Wisdom Wednesday: Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis is a condition in which your immune system attacks your thyroid. The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your body’s activities.

The thyroid is responsible for general metabolism. It facilitates the Krebs’s Citric Acid Cycle to provide energy for every cell in the body. Thyroid hormone is what gets you out of bed in the morning. During the day, various stressors stimulate the adrenals to produce additional hormones to further facilitate general metabolism.

The inflammation from Hashimoto’s thyroiditis often leads to an underactive thyroid gland (hypothyroidism).

Hashimoto’s disease is the most common cause of hypothyroidism in the United States. It primarily affects middle-aged women but also can occur in men and women of any age and in children. It is estimated that one in three cases of hypothyroidism is caused by Hashimoto’s disease, but I feel that statistic is low and it’s much closer to 50% of cases clinically in my office.

The signs and symptoms of hypothyroidism include fatigue, increased sensitivity to cold, constipation, pale, dry skin, puffy face, hoarse voice, unexplained weight gain, hair loss (especially the lateral third of the eyebrows) and depression. The two male patients currently in my practice with Hashimoto’s thyroiditis are both underweight. One has none of the common symptoms but does suffer from seizures and apnea, both associated with this disease. The other exhibits constipation as the only common symptom.

The low diagnostic rate is due to a lack of testing. The TSH (thyroid stimulating hormone) is the “gold standard” for diagnosing a thyroid problem. However, the TSH is a pituitary hormone that stimulates the thyroid and not really a thyroid hormone. It works through negative feedback. The hypothalamus monitors T3 and T4 production (the real thyroid hormones). When the level of T3 or T4 drops, the hypothalamus tells the pituitary gland to release more TSH, this stimulates the thyroid to make more hormone. As the thyroid hormone levels rise, the hypothalamus tells the pituitary to make less TSH. So TSH regulates thyroid hormone production and is a useful tool in looking for thyroid problems.

However, often the TSH is well within medical norms and a significant thyroid issue exists. In part this is due to the wide range of normal set by the laboratory industry. The norm is 0.4 to 4.5 uIU/mL. The American College of Endocrinology established a normal range of 1.0 to 2.0 uIU/mL in 2002 that has been largely ignored.

Monday, May 16, 2016

The Zika Virus

Zika is a virus first discovered in 1947 and named after the Zika forest in Uganda. The first human cases of Zika were detected in 1952, but until last year there had been only isolated outbreaks occurring mainly in tropical locales.

Zika is spread primarily through the bite of an infected Aedes aegypti or Aedes albopictus mosquito. Mosquitoes become infected by drinking the blood of a person infected with Zika, and then spread the disease to other people.

A man infected with Zika can transmit the virus through sexual intercourse. Also, people can be infected if they are given a blood transfusion tainted with Zika.

Four out of five people infected with Zika do not develop any symptoms. Those who do most often suffer from mild symptoms that include fever, rash, joint pain or red eyes.

The true risk of Zika is to a developing fetus. The U.S. Centers for Disease Control and Prevention has confirmed that Zika can cause terrible birth defects if a pregnant woman is infected with the virus.

Microcephaly is the most common birth defect caused by Zika, and it involves abnormally small development of the head and brain. Zika also causes other brain-related birth defects, and can result in miscarriage, according to the CDC. Not every fetus exposed to Zika develops a birth defect but no one knows what the odds are that a birth defect will occur.

Women of child-bearing age who live in an active Zika region should protect themselves from mosquito bites by wearing long-sleeved shirts and long pants, using mosquito repellent when outside, and staying indoors as much as possible. Women should use condoms or refrain from sex with a male partner if they are living in an active Zika area. They also should follow these precautions for a least 8 weeks if the man has traveled to an active Zika area, or for at least 6 months if the man has been diagnosed with Zika.

Friday, May 13, 2016

Medical Errors: A Hidden Killer

Medical errors may be the third leading cause of death in the United States, a new study contends.

John Hopkins University researchers analyzed eight years of U.S. data and concluded that more than 250,000 people die each year due to medical errors.

However, “incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics,” said Dr. Martin Makary, a professor of surgery at Baltimore-based Hopkins.

The CDC’s data collection method does not classify medical errors separately on a death certificate, according to the study authors, who called for changes to that criteria.

“The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used,” Makary explained in a university news release.

The Hopkins researchers examined four separate studies that analyzed medical death rate data from 2000 to 2008, including two that used data from federal agencies.

Then, using hospital admission rates from 2013, the investigators extrapolated that information, and based on a total of over 35 million hospitalizations, more than 251,000 deaths stemmed from a medical error. That translates to 9.5% of all U.S. deaths each year, the study authors said.

But the CDC data paints a different picture.

The CDC statistics show that in 2013, over 611,000 people in the United States died of heart disease, nearly 585,000 died of cancer and about 150,000 died of chronic respiratory disease.

Wednesday, May 11, 2016

Wisdom Wednesday: When to take Your Supplements

Supplements are just that, a supplement to the diet. To be utilized properly, their consumption must be coordinated with food. With herbal preparations, the time of day is often the key to creating the benefit desired.

I use a supplement schedule sheet in the office with headings for: upon awakening, breakfast, 10 AM, lunch, 3 PM, dinner, at bedtime. Despite these headings, patients frequently ask “when to I take these?” So here are some general guidelines.

Fats should be taken with meals and the meal should contain some fat as well. This includes fish oil, flax seed oil, black current seed oil, lecithin, Co Q10, and PS. Fats do not enter the blood stream through the digestive tract like other foods. Instead, they are absorbed into the lymphatic system or GALT (gut associated lymphatic tissue) then dumped into general circulation near the heart. This provides the heart with plenty of fat for fuel. However, if fatty supplements are taken without other fats, absorption is dramatically diminished.

Studies on the fatty herb Boswellia show the blood values are 500% higher when taken with other fats. This increased absorption is required for a therapeutic effect. When I first used Boswellia in my practice I saw no obvious benefit until I learned to recommend it with other fats. Today it is one of the most common anti-inflammatory products I utilize.

Most supplements should be taken with meals. This includes whole food supplements and many fractionalized supplements as well. The small multiple dosing keeps the blood values high in the same way that small frequent meals keep the macronutrients available. If in doubt, take the supplement with meals.

Probiotics should be taken immediately after meals, despite what the directions on the bottle may say. The harsh acidic environment of the stomach will kill most probiotics. However, when food is present, the pH of the stomach rises and the probiotic can ride the food bolus down through the digestive tract to the colon to propagate.

Monday, May 9, 2016

Doctors Issue Call to Combat Climate Change

Climate change is already harming people’s health by promoting illnesses linked to warmer temperatures and changing weather patterns, a leading group of U.S. doctors says in a new position paper.

As a result, the American College of Physicians (ACP) is calling for “aggressive, concerted” action to fight climate change by curbing man-made greenhouse gas emissions.

Respiratory illnesses, heat stroke and infectious diseases like Zika virus, dengue fever and cholera are flourishing as global temperatures rise, said Dr. Wayne Riley, president of the college.

“Our climate is already changing and people are already being harmed. If we don’t begin to address climate change, we’re going to see more and more manifestations of these health problems,” Riley said.

“There is clear, compelling scientific consensus that climate change is real,” he added. “There is no dispute.”

In the paper, published online April 19 in the journal Annals of Internal Medicine, the ACP outlines the health problems that it says climate change is already creating:

Respiratory illnesses, including asthma and COPD. Rising temperatures are causing an increase in ozone pollution, smoke from wildfires, and allergens produced by weeds, grasses and trees. Homes affected by heavy rains or flooding can become host to toxic mold and fungi.

Heat-related illnesses, such as heat exhaustion and heat stroke, which are particularly dangerous for children and the elderly

Insect-borne illnesses, like Zika virus, dengue fever and chikungunya, which are ranging father north as mosquitoes thrive in warmer climates.

Friday, May 6, 2016

Many Breast Cancer Patients May Not Need Chemo

A genetic test called MammaPrint determined that nearly half the women slated for chemotherapy based on standard clinical assessments didn’t really need to undergo the challenging treatment.

After surgery to remove their tumors, breast cancer patients with a MammaPrint score recommending against chemotherapy had a 95% survival rate, said co-researcher Laura van’t Veer, the test’s inventor.

“That’s very high, and we showed that it doesn’t differ between those who are treated and those who are not treated by chemotherapy,” said van’t Veer, leader of the breast oncology program at the University of California, San Francisco Diller Family Cancer Center.

The clinical trial involved nearly 6,700 women at 111 medical centers in nine countries. It “represents what we in medicine call the highest level of evidence,” AACR President Dr. Jose Baselga said.

“This study is telling us in a very clear way we can spare many women chemotherapy,” said Baselga, chief medical officer of Memorial Hospital at Memorial Sloan Kettering Cancer Center, in New York City.

Previously, doctors guessed whether a woman needed chemo by measuring the tumor, examining its cells under a microscope, and using genetic testing to determine whether the tumor would respond to hormone therapy, Baselga said.

Wednesday, May 4, 2016

Wisdom Wednesday: Eight Most Popular Diets – A Summary

Wow, that was a long series. I hope it gave you some options for improving your diet and maybe some understanding of why others choose to eat the way they do.
Although I learned a lot myself, I’m ready to move on to a new topic. But before I do, let me share some common threads to all these diets.

  • Plant-based – Obviously, the Vegan and vegetarian diets are solely plant-based, but plants as a majority of the food intake was a common even in the Atkins Diet, after the induction phase.
  • Limited Grains – The Paleo Diet excludes them completely, and some diets limit them to whole grains. Processed wheat, rice, and corn are the downfall of diets worldwide. It’s how we feed the masses, but they are nothing more than empty calories. They will sustain life, but not health.
  • Whole food – Avoiding processed foods whenever possible was also a common thread. Eat a piece of fish rather than drinking a protein shake. They both contain about 15 grams of protein, but the real thing is much better than the processed food.
  • Raw versus Cooked – Obviously, the Raw Food Diet is at the extreme, but all the diets promote eating a large percentage of your fruits and vegetables raw. If you have a thyroid issue, then avoid eating the cruciferous vegetables (broccoli, cauliflower, cabbage, etc.) raw as they are goitrogens. Otherwise, I recommend about 50% of your diet be composed of raw fruits and vegetables.
  • Adequate protein intake – All the diets focused on eating protein frequently. This can be a problem with the vegetarian diet. However, Americans often eat too much protein. (They generally just eat too much of everything) About 45 grams of protein per day is adequate. Make sure you have some protein at every meal, especially breakfast. A protein snack is a good idea as well.
  • Healthy fats – This is a real change in thinking for many. Fat has been demonized for the past generation and many healthy fats have disappeared from our diet. Some fats, like the omega 3 and omega 6 fatty acids are essential. We cannot manufacture them from other foods, they must be in the diet to sustain life. But many fats are healthy, in fact, it’s the “reduced fat” products that contain most of the trans-fats that are so unhealthy. The data never supported a low-fat diet as a preventative for heart disease. It was just manipulated to support the need to lower serum cholesterol by selling statin drugs. I know this is hard for many of you, but add those healthy fats back into your diet. Fat is extremely satiating. I honestly believe that the loss of healthy fats from the American diet is a major factor in our epidemic with obesity.

The Bottom Line:
So pick one of these diet formats that fits your lifestyle. Or maybe combine some aspects from a couple of them. I think the Mediterranean Diet is the easiest for Americans to follow, but I like aspects of all of them. The key is to find the format that works for you, something you can adopt as a lifestyle rather than constantly “trying to diet”. Next week I’ll review when to take your supplements.

The South Beach Diet

The Raw Food Diet

The Mediterranean Diet

Weight Watchers

The Vegan Diet

The Vegetarian Diet

The Zone Diet

The Atkins Diet

The Eight Most Popular Diets - Introduction

Monday, May 2, 2016

Cities May Have Distinct Microbial ‘Citizens’, Too

Every city has its own character, and new research suggests that could even extend to a municipalities microbial communities.

Researchers analyzed microbes collected over one year from three office in each of three places: Flagstaff, Arizona, San Diego and Toronto. Microbes are bacteria, viruses and fungi that are too small to see without a microscope.

The Flagstaff office had richer microbial communities than those in San Diego or Toronto, which were more similar. But, the reasons for those differences are unknown, according to the study published April 12 in the journal mSystems.

The researchers also found that human skin is a major source of office microbes and that office floors have more microbes than walls or ceilings, likely due to materials carried in on workers’ shoes.

Study senior author J. Gregory Caporaso, assistant director of the Center for Microbial Genetics and Genomics at Northern Arizona University, said in a journal news release that the discovery that each city had unique microbial communities was “especially interesting.”

“Even within each city, the offices we studied differed from each other in terms of size, usage patterns and ventilation systems, suggesting that geography is more important than any of these features in driving the bacterial community composition of the offices within the ranges that we studied,” he said.