Friday, December 29, 2017

Genes Start Mutating Soon After Life Begins

Hundreds of minor genetic mutations start to form in the cells of an embryo soon after conception, researchers have discovered.

The Yale University and Mayo Clinic scientists said that many of these mutations occur as sex cells are forming in the embryo. That means they can become part of the embryo’s genome and be passed on to the next generation.

“This opens up a larger perspective on human development,” study author Flora Vaccarino, a neuroscience professor at Yale, said in a Yale news release. “Some of our genome does not come from our parents.”

These early genetic mutations are also similar to those found in cancers, according to the researchers. They said this suggests that cancers can occur as a normal byproduct of cell division.

They added that their findings may provide new insight into the causes of neurodevelopmental disorders such as schizophrenia or autism. These conditions are primarily the result of genetic abnormalities, but no single gene inherited by parents has been found to cause a large number of cases.

The study may also help explain why one identical twin might have a genetic disorder while the other is healthy, or why some members of a family who carry a disease-causing mutation do not get sick, the researchers said.

The findings were published Dec. 7 in the journal Science.

My Take:
The next question is what is driving these genetic mutations? Environmental factors first come to mind but are some of the mutations random? What about maternal health and nutrition? How about paternal health issues prior to conception? If the mutation is favorable, does it offer enough advantage that it will be carried forward to future generations?

Friday, December 22, 2017

New Hope for Kids with Multiple Food Allergies

A treatment for kids with more than one dangerous food allergy show promise in early trials, researchers say.

Almost one-third of people with a food allergy have reactions to more than one type of food. This can increase the risk of accidental exposure and life-threatening anaphylaxis, according to researchers at Stanford University School of Medicine.

No treatment exists for multiple food allergies. Usually, patients are told to avoid the food triggers, but this requires constant attention to their diet.

“Patients find it very hard to live with multiple food allergies,” said study senior author Dr. Sharon Chinthrajah. “It puts a huge social and economic burden on families.”

In this new study, scientists combined the asthma drug omalizumab (Xolair) with immunotherapy for 48 children with more than one food allergy.

Immunotherapy exposes patients to tiny amounts of the foods that cause their allergic reactions. Gradually, the allergen dose is increased until the patient can tolerate normal amount of the food.

Taking omalizumab appeared to speed up the desensitization process without sacrificing safety, the researchers said.

The study participants were randomly assigned to receive the combined allergy treatment or a placebo. They were 4 to 15 years old and were allergic to a variety of foods, including almonds, cashews, eggs, hazelnuts, milk, peanuts, sesame, soy, walnuts and wheat.

The researchers found that after eight weeks of treatment 83% of the treatment group could tolerate a small dose of two food allergens versus 33% who took the placebo.

Wednesday, December 20, 2017

Wisdom Wednesday: If Mom Has Rheumatoid Arthritis, Baby May Develop It Too

Children born to mothers with rheumatoid arthritis are at increased risk for the disease and other chronic health problems, a new study suggests.

The finding comes from an analysis of long-term follow-up data on all children born in Denmark in a 25-year period. That included more than 2,100 children born to women diagnosed with rheumatoid arthritis before pregnancy and 1.3 million children born to women who did not have the disease.

The children born to women with the disease were almost three [times] more likely to develop rheumatoid arthritis themselves, the study found. They also had a 2.2 times greater risk for thyroid disease and a 1.6 higher risk for epilepsy.

The study was published online Dec. 11 in the journal Arthritis Care and Research.

“Our results call for special attention on child development of rheumatoid arthritis, thyroid disease and epilepsy if exposed to rheumatoid arthritis in utero,” researcher Line Joelving said in a journal news release. She’s with the Centre for Clinical Epidemiology at Odense University Hospital in Denmark.

Monday, December 18, 2017

Postmenopausal Women Should Still Steer Clear of HRT

Yet again, the nation’s leading authority on preventive medicine says postmenopausal women should avoid hormone replacement therapy (HRT).

The U.S. Preventive Services Task Force is standing by its original recommendation that women who have already gone through menopause should avoid using female hormones to guard against osteoporosis or diabetes, said task force chairman Dr. David Grossman, a senior investigator at the Kaiser Permanente Washington Health Research Institute in Seattle.

“Basically, the task force concluded there was no overall benefit from taking hormones to prevent chronic conditions,” Grossman said. “There are some benefits, but we believe those potential benefits are outweighed by the harms, making this essentially no net benefit overall.”

The advisory covers all formulations of hormone replacement therapy, the task force said. The therapy can consist of pills or patches containing either estrogen or an estrogen/progesterone mix.

However, women undergoing menopause can use hormone replacement therapy short-term to treat symptoms such as hot flashes and vaginal dryness, said Dr. Suzanne Fenske, an assistant professor of obstetrics, gynecology and reproductive science with the Icahn School of Medicine at Mount Sinai in New York City.

“Hormone replacement therapy does still have a benefit to women with menopause whose symptoms do not respond to other treatment options,” Fenske said. “It really should be used to manage menopausal symptoms, rather than being used for any sort of preventative medicine.”

The task force first recommended against hormone replacement therapy for postmenopausal women in 2012. It updates its recommendations every four years to make sure they reflect the latest medical evidence.

Friday, December 15, 2017

For Breast Cancer Patients, Less Time on Hormonal Meds?

Women with earlier-stage breast cancer may be able to spend less time on hormonal therapy without dimming their prognosis, a new study suggests.

In a trial of nearly 3,500 patients, researchers found that seven years of hormonal therapy was as effective as 10 years. By the study’s end, more than three-quarters of women in both groups were alive and recurrence-free.

The results are “important,” according to experts attending the San Antonio Breast Cancer Symposium, where the study was released Thursday.

Hormonal therapy involves drugs that block estrogen from fueling the growth of breast cancer cells. They include tamoxifen and a group of medications called aromatase inhibitors, such as anastrozole (Arimidex).

The problem is, the drugs can have difficult side effects like bone fractures hot flashes, sexual dysfunction and muscle and joint pain.

Some women do well on the medications, while others “feel terrible and want to come off them,” said Dr. Susan Domchek, of the University of Pennsylvania’s Abramson Cancer Center.

So, treatment decisions are always individual, she said, based on various factors, including a women’s personal likelihood of having a breast cancer recurrence.

Wednesday, December 13, 2017

Even Non-Heart Surgery May Harm Your Heart

Older adults commonly suffer damage to heart cells during various types of surgery – even non-heart related surgeries – and it can significantly raise their risk of dying from the procedure, a new study finds.

The research looked at a phenomenon called perioperative myocardial injury, or PMI. It refers to subtler heart damage that can happen during or soon after any type of surgery. Old patients and those who already have heart disease are at increased risk.

However, the condition is easily missed because most of the affected patients have no chest pain or other symptoms, according to Dr. Christian Puelacher, the first author on the new study. He’s a clinical researcher at Cardiovascular Research Institute Basel in Switzerland.

Puelacher’s team found that PMI may happen more often than doctors have typically thought: Of more than 2,000 high-risk patients screened, 1 in 7 developed PMI after a non-cardiac surgery, the study found.

“This suggests we’ve underestimated the number of myocardial [heart] injuries that occur during non-cardiac surgery,” said Dr. Alistair Phillips, co-chair of the surgeons’ section leadership council for the American College of Cardiology.

The cases were found because all of the patients – treated at the University Hospital Basel in Switzerland – were screened for PMI with a newer blood test: a so-called “high sensitivity” troponin test, which detects elevations in the heart protein troponin. When troponin levels rise, it’s a sign of heart damage, Phillips explained.

Monday, December 11, 2017

Birth Control Pill Tied to Slight Rise in Breast Cancer Risk

Newer versions of the birth control pill carry a similar increased risk of breast cancer as earlier ones that were abandoned in the 1990s, a new study reveals.

Woman taking modern formulations of the pill have a 20% increased risk of breast cancer compared with those who’ve never been on hormonal contraception, the study of almost 2 million Danish women found.

“The risk increases with increasing duration of use and persists for more than five years, if used for longer than five years,” said study author Lina Morch, a senior epidemiologist with the University of Copenhagen in Denmark.

Still, experts cautioned that the absolute risk of breast cancer for any one women on the Pill remains very low.

Nevertheless, a similar amount of risk prompted the U.S. Food and Drug Administration to yank high-estrogen formulations of the pill off the market back in the early 1990s, said Mia Gaudet, strategic director of breast and gynecologic cancer research for the American Cancer Society.

“There had been some changes to oral contraceptive formulations in the ‘90s, and there was the hope those formulations would result in a lower risk of breast cancer,” said Gaudet, who was not part of the study. “We see from this data that is not the case.”

The first wave of birth control pills contained doses as high as 150 mg of estrogen. As research began to link estrogen to breast cancer, the FDA took off the market any formulations that had more than 50 mg of estrogen, Gaudet said.

Friday, December 8, 2017

Intense Workouts May Boost Memory

The study of 95 healthy young adults showed that six weeks of 20-minute bouts of interval training led to significant improvements in what’s called high-interference memory. An example of this type of memory is distinguishing your car from another of the same make and mode.

Canadian scientists also found these workouts led to increases in a protein involved in the growth, function and survival of brain cells. The results were published in the November issue of the Journal of Cognitive Neuroscience.

The findings could prove important as an aging population leads to higher rates of Alzheimer’s disease and other types of dementia, according to the researchers from McMaster University in Hamilton, Ontario.

“Improvements in this type of memory from exercise might help to explain the previously established link between aerobic exercise and better academic performance,” said study author Jennifer Heisz. She’s an assistant professor in the department of kinesiology at McMaster.

“At the other end of our lifespan, as we reach our senior years, we might expect to see even greater benefits in individuals with memory impairment brought on by conditions such as dementia,” she added in a university news release.

The researchers are now assessing how exercise and metal training affects high-interference memory in older adults. “One hypothesis is that we will see greater benefits for older adults, given that this type of memory declines with age,” Heisz said.

Wednesday, December 6, 2017

Wisdom Wednesday: DAO Deficiency

Diamine oxidase (DAO) is the major enzyme involved in histamine metabolism and is responsible for ensuring a steady histamine level required for the balance of numerous chemical reactions taking place in the body.

DAO is the key enzyme responsible for the degradation of extracellular (free) histamine, regardless of whether the histamine originates from allergy-induced processes in the body or is consumed with food.

Histamine exerts its effects by binding to its 4 receptors: H1R, H2R, H3R and H4R on target cells in various tissues. Histamine receptors are located all over the body and have many important functions including:
  • H1 receptors: Smooth muscle and endothelial cells affecting skin; blood vessels (Benadryl and Claritin block activity of these receptors)
  • H2 receptors: Cells in the intestines control acid secretion, abdominal pain, and nausea; heart rate
  • H3 receptors: Central nervous system controlling nerves, sleep, appetite and behavior.
  • H4 receptors: Thymus, small intestine, spleen, colon, bone marrow and white blood cells; inflammatory response

The DAO gene is also involved in the metabolism of glutamate, an excitatory neurotransmitter found to be elevated in those with schizophrenia and bipolar disorders. The DAO snippet can be identified in genetic testing, like 23andme. If you have a primary deficiency it can lead to significantly reduced DAO enzyme activity. Individuals with a DAO gene mutation may have a tendency towards high histamine.

The DAO enzyme is dependent on vitamin B6, B12, iron, copper and vitamin C. Excess zinc will prevent copper absorption and may also be an issue in the diet.

Monday, December 4, 2017

Hospital Midwives, Lower C-Section Rates?

Expectant mothers seeking to lower their risk of a cesarean delivery might want to consider getting a midwife involved, a new study suggests.

In addition, midwives were tied to less need for a surgical incision called an episiotomy during childbirth, the researchers reported.

“More midwife-attended births may correlate with fewer obstetric procedures, which could lower costs without lowering the quality of care,” wrote study co-authors Laura Attanasio, of the University of Massachusetts Amherst, and Katy Kozhimannil of the University of Minnesota School of Public Health.

The study findings are based on 126 hospitals in New York state.

About 25% of those hospitals had no midwives. About half had midwives, but they attended less than 15% of births. At 7% of the hospitals, however, midwives attended more than four out of 10 births, according to the study.

In 2014, when the research was conducted, midwives were present at only 9% of U.S. births, the researchers noted. In other western countries – such as Australia, France and the United Kingdom – midwives attend two-thirds of births.

“This study is contributing to a body of research which shows that good outcomes for women at low risk in childbirth go hand-in-hand with lower use of medical procedures,” Attanasio said in a news release from the universities.

Friday, December 1, 2017

It’s the Latest Diet Craze, But Is It Safe?

A nutritional fad called CICO – short for “Calories In, Calories Out” promises you can eat whatever you want, junk food included, and still shrink your waistline – as long as every day you expend more calories than you consume.
It’s a simplified approach to eating that essentially views fruits and vegetables through the same prism as candies and soda. All that matters is the total caloric tally.

Perhaps not surprisingly, many nutritional experts disagree. “Be healthy isn’t just about weight loss alone,” noted Lona Sandon, program director and assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas. “You have to consider the whole package.”

Sandon acknowledged that those who adopt a CICO approach to eating “might actually lose weight.” But there’s a downside: “nutrient deficiencies or even malnutrition,” she warned.

“You may not be providing all the nutrients your body needs if you are not paying attention to the types of foods you are putting in your body,” Sandon Said. “This could mean osteoporosis later in life, increased risk of cancer, heart disease, etcetera.”

Dietitian Connie Diekman added, “Weight loss, in an unhealthy way, is never a good idea.” She’s director of university nutrition at Washington University in St. Louis. “Managing calories to achieve weight loss is important, but if important nutrients are missing, then muscle mass will decline, bone health, mental acuity and many other essential functions will be compromised,” Diekman said.

Wednesday, November 29, 2017

Wisdom Wednesday: Taking Four or More Prescription Meds? Consider Scaling Back

More than half of Americans regularly take about four prescription medications, increasing the likelihood that mistakes could occur, according to Consumer Reports.

People taking multiple prescription medications should visit their doctor for a “medication checkup.”

By showing their doctor or pharmacist a comprehensive list of every drug they are taking, including vitamins and other dietary supplements, patients can be warned about potentially harmful interactions. They can also find out if any of these medications are no longer necessary, which would save them money.

Consumer Reports encourages patients to have this type of medication review at least once a year.

“Much medication use is lifesaving, without a doubt. But some drugs can potentially do more harm than good,” said Lisa Gill, deputy editor of Consumer Reports. “Our concern is that inappropriate prescribing can lead to unnecessary risk, including trips to the emergency room,” she said in a news release from the organization. “We hope to encourage consumers to talk with their health care providers about the meds and supplements they take, so they can ultimately lower their risk,” Gill said.

Use of prescription drugs has surged over the past 20 years. The U.S. population has increased just 21%, but the total number of prescriptions filled by Americans has surged 85% - from 2.4 billion prescriptions in 1997 to 4.5 billion in 2016, Consumer Report said.

“There are many root causes, including a ‘culture of prescribing.’ Perhaps most worrisome is prescribing for pre-disease stages of a condition, such as pre-osteoporosis or pre-diabetes, where the medications offer limited benefit for people,” Gill said. “And we’ve seen a push to treat common problems like back pain, heartburn and insomnia with medication before trying effective, non-drug measures first,” she said.

People who are on multiple medications also need to be extra careful about possible interactions.

Monday, November 27, 2017

These Foods May Help Ease Rheumatoid Arthritis Pain

Have rheumatoid arthritis? Treat yourself to some blueberries and a cup of green tea. They’re among the foods that could ease the pain, swelling and stiffness in your joints and even slow progression of the disease, researchers say.

Dried plums, pomegranates, whole grains, the spices ginger and turmeric, and olive oil may also help. These foods appear to reduce inflammation, as well as joint stiffness and pain, according to the authors of a paper published Nov. 8 in the journal Frontiers in Nutrition.

“Regular consumption of specific dietary fibers, vegetables, fruits and spices, as well as the elimination of the components that causes inflammation and damage, can help patients to manage the effects of rheumatoid arthritis,” study author Bhawna Gupta said in a journal news release. Gupta is an assistant professor in the School of Biotechnology at KIIT University in Odisha, India.

“Patients suffering from rheumatoid arthritis should switch from omnivorous diets, drinking alcohol and smoking to Mediterranean, vegan, elemental or elimination diets, as advised by their doctor or dietitian, Gupta said. An omnivorous diet includes foods from both plant and animal sources. Incorporating probiotics – foods like yogurt and dietary supplements that contain beneficial microorganisms – can also help, she said.

Treatment of rheumatoid arthritis includes anti-rheumatic drugs, which can be costly.

“Supporting disease management through food and diet does not pose any harmful side effects and is relatively cheap and easy,” Gupta said.

My Take:
This report is interesting, but a little confusing. The Mediterranean diet is an omnivorous diet, including fish and occasional lean meats. It also includes wine, they drink quite a bit of wine in the Mediterranean region. The kids start about the age of seven.

The blueberries, green tea, dried plums and pomegranates are all good sources of anti-oxidants that limit or prevent damage to the body. The spices ginger and turmeric are both anti-inflammatory but turmeric reduces prostaglandins not typically found elevated in rheumatoid arthritis. Prostaglandins are frequently increased in musculoskeletal injuries, like osteoarthritis.

Ginger does reduce leukotrienes, inflammatory chemicals from the immune system that increase in autoimmune disease like rheumatoid arthritis. However, ginger is typically not very effective in treating true rheumatoid arthritis. In fact, when ginger tests well and helps reduce the inflammation associated with rheumatoid arthritis, I question the diagnosis (which I often do).

Friday, November 24, 2017

Gut Bacteria May Change Rapidly After Severe Injury

After a severe traumatic injury, the composition of a patient’s intestinal bacteria quickly changes – a phenomenon that could affect the patient’s prognosis, new research suggests.

The finding that the gut’s so-called “microbiome” experiences a depletion in the presence of some bacteria and an increase in the presence of others came from a small investigation, involving 12 critically injured adults. The patients were aged 20 to 85.

Stool samples were collected from each person three times: when they were admitted to the hospital, and then 24 and 72 hours later. The samples were compared with those from 10 other patients who had not sustained traumatic injury.

Samples taken at the time of admission were similar in both groups. But within 24 hours, differences started to show, the investigators found. By 72 hours, three types of bacteria were depleted in the traumatic injury group, relative to the non-injury group, and the levels of two other types of bacteria had risen.

“The short time-course in which such alterations occur is also notable – such relatively rapid alterations in intestinal microbiota represent a critical and previously unrecognized phenomenon that may influence clinical course and outcomes after severe trauma,” the study authors wrote in the report.

The study was published online Oct. 23 in Trauma Surgery & Acute Care Open.

The study team, lead by Dr. Benjamin Howard from the department of surgery at San Francisco General Hospital, said more research is needed to further explore the phenomenon. But the researchers added that the findings so far point to the possibility that intestinal bacterial composition could in some way be critical to patient outcomes after a traumatic injury.

Wednesday, November 22, 2017

Wisdom Wednesday: Definition of High Blood Pressure Drops

Nearly half of all adult Americans will be considered to have high blood pressure under new guidelines issued Monday by the nation’s top health organizations.

The new guidelines lower the diagnostic threshold for stage 1 high blood pressure to 130/80, down from the previous level of 140/90, according to a joint statement from the American Heart Association and the American College of Cardiology.

Further, the guidelines also call for more aggressive treatment of high blood pressure, asking doctors and patients to set 130/80 as the new goal of therapy.

High blood pressure can lead to heart attacks, strokes and heart failure.

But the guidelines also press for more judicious treatment of high blood pressure – sometime called hypertension – and an emphasis on lifestyle risk factors. Prescriptions for blood pressure drugs are not expected to leap under the guidelines, experts said.

The two heart organizations announced the new guidelines Monday at the American Heart Association’s annual meeting, in Anaheim, Calif. The guidelines were last revised in 2003.

This change means that 103 million Americans well be considered to have high blood pressure, or about 46% of the adult population, said Dr. Paul Whelton. He is chair of the 2017 Hypertension Practice Guidelines and a professor of Global Public Health at Tulane University School of Public Health and Tropical Medicine in New Orleans.

The impact of the new guidelines is expected to be greatest among younger people. High blood pressure is expected to triple among men under age 45 and double among women under 45, according to the guidelines report.

Monday, November 20, 2017

Are Some Heartburn Meds Tied to Stomach Cancer?

Popping certain heartburn drugs like they’re candy might up your odds for stomach cancer, new research suggests.

The risk was proportionate to how long and how often these drugs, called proton pump inhibitors (PPIs), were taken. That risk increased anywhere from two to eight times, the study authors said.

Although the relative risk seems high, the absolute risk was small. But it was statistically significant, especially for people infected with Helicobacter pylori, a bacteria linked to stomach cancer, the researchers explained.

“While PPIs are one of the most commonly used medications for treating reflux disease as well as dyspepsia, clinicians should exercise caution when prescribing long-term PPIs, even to patients who have H. pylori eradicated,” said lead researcher Dr. Wai Keung Leung. He is a professor of gastroenterology at the University of Hong Kong.

PPIs include commonly used drugs like Prilosec, Nexium and Prevacid.

Eliminating H. pylori lowers the risk of stomach cancer significantly, Leung noted. But even after the bacteria is treated, many people still develop stomach cancer.

Stomach cancer is the third leading cause of cancer death in the world and earlier studies have found a link between PPIs and stomach cancer. But the role of H. pylori was less clear.

To try to assess the role the bacteria played, Leung and his colleagues compared the use of PPIs with another class of drugs used to lower stomach acid – histamine H2-receptor antagonists (H2 blockers). The study followed nearly 63,400 patients treated with a combination of a PPI and two antibiotics to kill H. pylori. The treatment was given over seven days between 2003 and 2012. The patients were followed for an average of seven years, until the participants either developed stomach cancer, died, or the study ended.

Friday, November 17, 2017

Are Artery-Opening Stents for Chest Pain a Waste of Time?

A new study suggests that the placebo effect of stents in heart patients with chest pain may be far more pronounced than thought. That could mean that drug therapy alone, rather than the pricey, artery-opening devices, is all that’s needed for certain patients, the researchers said.

“The most important reason we give patients a stent is to unblock an artery when they are having a heart attack. However, we also place stents into patients who are getting pain only on exertion caused by narrowed, but not blocked, arteries. It’s the second group that we studied,” explained lead author Rasha Al-Lamee, from the National Heart and Lung Institute at Imperial College London.

The study included 200 patients with stable angina who received six weeks of intensive drug treatment for their angina. After that, they either received a stent or underwent a simulated procedure where no stent was implanted.

Patients who received stents did not have more improvements in angina or quality of life than those who did not receive a stent. Angina is the medical term for chest pain. It is typically caused by the build-up of fatty plaques in the arteries.

Stents aren’t cheap, either: The devices and their insertion coasts from $11,000 to $41,000 at hospitals in the United States.

The study was published online Nov. 2 in The Lancet medical journal, to coincide with a presentation at a cardiology meeting in Denver.

Wednesday, November 15, 2017

Wisdom Wednesday: Endangered Plants with Medicinal Properties

Humans have used plants as medicine from the beginning of our time on Earth. The “doctrine of signatures” says that for every ailment there is a plant and the characteristics of that plant will tell you how to use it. However, the popularity of using these plants has grown exponentially in recent years. This has led to heavy pressure on the native population plants when they are collected from the wild. In some cases, overharvesting of a particular plant has led to their endangerment.

This is a list of just some of the endangered plants on our planet that are highly valued for the medicines that they provide:

Black Cohosh:
used by Native Americans to support women’s health during menopause and for menstrual issues. I use it for the same purposes. Studies indicate that its’ estrogenic activity is restricted to secondary sites like bone but I still avoid use with any history of breast cancer. Harvesting pressures, habit loss and invasive species have all contributed to its’ decline.

another North American herb. The root was used by indigenous tribes along the east coast to support the immune system. I use it for acute infections. Overharvesting is the major issue.

American Ginseng:
a perennial herb also native to Eastern North American. The root has many healing properties, including adaptogenic, cardiotonic, sedative and immune support. Overharvesting and habit loss are the primary issues.

Asian Ginseng:
The root has been used for thousands of years in China. It boosts many of the same properties as its’ American cousin. Due to overharvesting the majority of Asian Ginseng on the market today is cultivated.

Wild Yam:
native to North America, Mexico and Asia. The roots and stems are used for inflammation, as a digestive aid, to support healthy blood sugar, and as an antioxidant. I use it as a natural source of progesterone as the precursors found in the plant are converted in the stomach. Topical Wild Yam has no progesterone activity. It also has been overharvested.
Slippery Elm – native to Eastern and Central U.S. and into Canada, the mucilaginous inner bark of the tree has many uses, including soothing coughs, sore throat, and digestive inflammation. I use it as a prebiotic with its high soluble fiber content and as an anti-inflammatory for the gut. Dutch elm disease and aggressive harvesting practices have severely threated this tree.

What can you do to help endangered medicinal plants?

First, purchase them only from well-respected sustainable companies, preferably those who cultivate rather than harvesting in the wild. Medi-Herb, my favorite herb company has discontinued the use of certain herbs on the endangered list.

Second, you can learn to grow many medicinal plants yourself. Most of the plants listed above are native to the U.S. Please visit to view and purchase herbs that are endangered or at risk. Black cohosh, Echinacea angustifolia, Goldenseal, and Slippery Elm are all available and reasonably priced.

The Bottom Line:
Please do what you can to preserve herbal plant life. Your health may depend on it someday.

Monday, November 13, 2017

Treeless Tropics, More Disease-Carrying Mosquitoes?

Deforestation doesn’t just strip the landscape. In tropical regions, it may also lead to more disease-carrying mosquitoes, University of Florida researchers say.

“Converting pristine tropical forests into areas for agriculture or other uses creates a habitat for the mosquitoes that transmit human diseases,” lead study author Nathan Burkett-Cadena said in a university news release. He’s an assistant professor of entomology.

The scientists don’t say why those mosquitoes might thrive without extensive tree coverage, but they note that deforested areas are warmer and drier than similar pristine forests.

For their report, the researchers analyzed 17 studies from around the world. They found a strong link between deforestation in tropical habitats and higher concentrations of mosquitoes that carry diseases transmittable to people.

Almost 57% of mosquito species in deforested areas were confirmed carriers of human disease, compared with about 28% of mosquito species in forested areas, the investigators said.

They also found that mosquito species capable of carrying multiple human diseases favored deforested habitats. These include Aedes aegypti mosquitoes, which transmit the dengue, West Nile, yellow fever and Zika viruses.

The last couple of decades have seen an increase in efforts looking into the association between deforestation and specific diseases,” said study co-author Dr. Amy Vittor.

Friday, November 10, 2017

Can You Trust the Labels on Your Supplements?

More than half of the herbal and dietary supplements analyzed by researchers contained ingredients that differed from the list on their labels. Some had hidden ingredients that might actually harm health, researchers said.

Bodybuilding and weight-loss supplements, in particular, tended to contain ingredients not listed on their packaging, said lead researcher Dr. Victor Navarro, chair of hepatology for Einstein Medical Center in Philadelphia.

Chemical analyses found that product labels did not reflect ingredients for 80% of body building and performance enhancement supplements, and 72% of weight-loss products, the researchers reported. “We found that half of the bodybuilding supplements in our analysis contained undeclared anabolic steroids,” Navarro said.

The researchers and health experts are concerned that these mystery ingredients can cause lasting liver damage. More than 20% of liver damage cases reported to the U.S. Drug-Induced Liver Injury Network are attributed to herbal and dietary supplements, the researchers said in background notes.

Navarro and his team analyzed more than 200 supplements reported to the liver injury network by hundreds of patients, to see whether their labels reflected the actual contents. Only 90 of 203 products had labels that accurately reflected their content, the investigators concluded.

The FDA does not regulate the supplement industry as it does pharmaceuticals and medical devices, Navarro noted.

Wednesday, November 8, 2017

Wisdom Wednesday: Your Thyroid Could Be Working Against Your Heart

Middle-aged and older adults with an elevated thyroid hormone may be at higher risk of heart disease and death, researchers found. In the new Dutch study, high and even high-normal levels of a hormone called free thyroxine (FT4) doubled the odds of having calcification of the coronary arteries. This can be a sign of atherosclerosis, commonly called hardening of the arteries.

Higher FT4 levels were also linked to an 87% greater risk of having a heart attack or stroke and twice the risk of dying from one. “High FT4 is indicative of an overactive thyroid,” explained lead researcher Dr. Arjola Bano, of Erasmus University in Rotterdam.

FT4 is produced in the thyroid gland at the front of the neck. It helps control the body’s rate of energy use, she said. Atherosclerosis means you have fatty deposits called plaque that can clog arteries. As plaque builds up, the artery narrows, reducing blood flow. Atherosclerosis can progress from thickening and hardening to the artery walls to heart disease, stroke and death, Bano said.

“Our findings suggest that FT4 measurement can help identify people at increased risk of atherosclerotic events,” she added.

Monday, November 6, 2017

Acetaminophen in Pregnancy Tied to ADHD Risk in Kids

Acetaminophen is considered the go-to pain medication during pregnancy. But a new study adds to evidence linking the drug to an increased risk of behavioral issues in kids.

Researchers in Norway found that among nearly 113,000 children, those whose mothers used acetaminophen during pregnancy were slightly more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD). The link was, however, confined to longer-term use – particularly a month or longer.

When moms used acetaminophen for 29 days or more during pregnancy, their kids were twice as likely to be diagnosed with ADHD, versus women who did not use the drug. On the other hand, when expectant moms used the drug for a week or less, their kids showed a slightly decreased risk of ADHD.

Acetaminophen is best known by the brand name Tylenol, but it’s an active ingredient in many pain relievers.

The new study, led by researcher Eivind Ystrom from the Norwegian Institute of Public Health in Oslo, is not the first to suggest a connection between prenatal acetaminophen and ADHD.

Around half of pregnant women use acetaminophen at some point, so it’s important to understand any risks, according to Christina Chambers, co-director of the Center for Better Beginnings at the University of California, San Diego. But with a study like this, she explained, it’s difficult to know whether factors other than acetaminophen are to blame – including the underlying conditions the women had.

Friday, November 3, 2017

Ob/Gyns Warn Against ‘Vaginal Seeding’ Trend for Newborns

“Vaginal seeding” is growing in popularity because it’s thought that babies born through Cesarean-section miss out on certain “helpful” vaginal microbes that might shield the infant from asthma, allergies and immune disorders.

“Vaginal seeding has become a rising trend for patients,” noted Dr. Jennifer Wu, an ob/gyn at Lenox Hill Hospital in New York City. “Patients read about the benefits of a vaginal delivery and hope to replicate these benefits with vaginal seeding.”

As explained by the American College of Obstetricians and Gynecologists (ACOG), it’s thought that contact with healthy vaginal bacteria helps stimulate the infant immune system, prevents the growth of dangerous bacteria and regulates the gut. That contact doesn’t happen for babies born via C-section, however, so in vaginal seeding, a cotton swab with vaginal fluids from the mother is used to transfer vaginal bacteria to a newborn.

But in a statement issued Oct. 24, ACOG – the nation’s largest ob/gyn organization – said the procedure is not recommended because the known risks outweigh any potential benefits. “Due to the lack of sufficient data, the very real risks [of vaginal seeding] outweigh the potential benefits,” Dr. Christopher Zahn, ACOG’s vice president of practice activities, said in a college news release. “By swabbing an infant’s mouth, nose or skin with vaginal fluid after birth, the mother could potentially, and unknowingly, pass on disease-causing bacteria or viruses,” he explained.

Wu agreed. “There are very real risks attached to this practice,” she said. “Certain viruses, such as group B step and herpes, can cause serious illnesses such as meningitis in newborns.”

Wednesday, November 1, 2017

Wisdom Wednesday: Do Statins Raise Odds for Type 2 Diabetes?

Cholesterol-lowering medications known as statins may lower your risk of heart disease, but also might boost the odds you’ll develop type 2 diabetes, new research suggests.

“In a group of people at high risk of type 2 diabetes, statins do seem to increase the risk of developing diabetes by about 30%,” said the study’s lead author, Dr. Jill Crandall. She’s a professor of medicine and director of the diabetes clinical trials unit at Albert Einstein College of medicine in New York City. But, she added, that doesn’t mean anyone should give up on statins.

“The benefits of statins in terms of cardiovascular risk are so strong and so well established that our recommendation isn’t that peoples should stop taking statins, but people should be monitored for the development of diabetes while on a statin,” she explained.

The new study is an analysis of data collected from another ongoing study. More than 3,200 adults were recruited from 27 diabetes centers across the United States for the study. All of the study participants were overweight or obese. They also showed signs that they weren’t metabolizing sugar property at the start of the study, but not poorly enough to be diagnosed with type 2 diabetes.

Study volunteers were randomly chosen to get treatment with lifestyle changes that would lead to modest weight loss, the drug metformin or a placebo pill. At the end of the intervention, they were asked to participate in the10-year follow-up program. They had their blood sugar levels measured twice a year, and their statin use was tracked, too.

Monday, October 30, 2017

Pollution Tied to 9 Million Deaths Worldwide in 2015

Pollution led to more than 9 million deaths worldwide in 2015, or 1 in 6 deaths that year, a new report reveals. Air pollution, the worst culprit, was linked to 6.5 million heart and lung related deaths. The Lancet Commission on Pollution and Health said.

Water pollution was tied to 1.8 million deaths, mostly from gastrointestinal and parasitic infections. And workplace related pollution and lead pollution also played a role, contributing o 800,000 deaths and 500,000 deaths respectively.

“Pollution is much more than an environmental challenge – it is a profound and pervasive threat that affects many aspects of human health and well-being,” said Dr. Philip Landrigan, co-lead of the commission. “It deserves the full attention of international leaders, civil society, health professionals, and people around the world,” added Landrigan, a professor at the Icahn School of Medicine at Mount Sinai in New York City.

The report is published in the Oct. 20 online issue of The Lancet. Two years in the making, it involved more than 40 international health and environmental authors.

“Our goal is to raise global awareness of the importance of pollution and mobilize the political will needed to tackle it, by providing the most in-depth estimates of pollution and health available,” Landrigan said in a journal news release.

Friday, October 27, 2017

A-Fib Hits Men Earlier Than Women

Men develop a dangerous type of irregular heartbeat called atrial fibrillation a decade earlier than women, a new study suggests. And being overweight increased odds for the condition in both sexes, those extra pounds were more troublesome for males, the German researchers found.

“It’s crucial to better understand modifiable risk factors of atrial fibrillation,” said study author Dr. Christina Magnussen. “If prevention strategies succeed in targeting these risk factors, we expect a noticeable decline in now-onset atrial fibrillation,” added Magnussen, a specialist in internal medicine and cardiology at the University Heart Center in Hamburg.

A-Fib means the upper chambers of the heart, or atria, quiver instead of beat. In the new 13-year study, the condition tripled the odds of dying prematurely. According to the American Heart Association statistics, as many as 6 million Americans have atrial fibrillation, with those numbers likely doubling by 2030.

In this study, researchers examined the medical records of nearly 80,000 people, aged 24 to 97, in Europe who initially did not have atrial fibrillation. Later assessments showed than more than 6% of men and over 4% of women had been diagnosed with A-Fib.

Risk of diagnosis accelerated sharply in men after 50 and in women after 60. By age 90, nearly one-quarter of men and women were told they had atrial fibrillation, the study found.

Wednesday, October 25, 2017

Wisdom Wednesday: ‘Good’ Cholesterol Might Actually Be Bad

A new study published in the European Heart Journal finds that “good” cholesterol, or high-density lipoprotein (HDL) cholesterol, may raise the risk of premature death.

By and large, the medical community suggest that higher levels of the good kind of cholesterol are desirable, as it may protect against heart disease and stroke. By contrast, it is the “bad” cholesterol, or low-density lipoprotein (LDL), that blocks the arteries.

The new research challenges this belief – at least in part. As the authors note, this is the first time that as study has drawn a connection between high HDL cholesterol levels and excessive mortality in the general population.

The study was carried out by researchers from the University of Copenhagen in Denmark. Prof. Borge Nordestgaard, of the university’s Department of Clinical Medicine, is the corresponding author of the study, and Christian M. Madsen, of the university’s Department of Clinical Biochemistry, is the paper’s first author.

Madsen and colleagues combined data from the Copenhagen City Heart Study, the Copenhagen General Population Study, and the Danish Civil Registration System. In total, they examined data on more than 116,000 people and clinically followed them for an average period of 6 years, during which time more than 10,500 people died.

Blood tests for both types of cholesterol levels were taken non-fasting, and statistically, the researchers adjusted for all known variables that are normally associated with all-cause mortality. Such factors included age, body mass index (BMI), smoking – both current and cumulative – alcohol consumption, physical activity, and diabetes.

The study found that men with extreme levels of HDL in their blood had a 106% higher chance of dying prematurely than men with normal levels of this type of cholesterol. Women with extremely high levels of HDL cholesterol were 68% more likely to die prematurely than women with normal levels.

Monday, October 23, 2017

Could Too Much Exercise Be Bad for Men’s Hearts?

A new study found white men who exercise more than seven hours a week have an 86% higher risk of developing plaque build-up in their arteries. No such elevated risk was seen among either black men or women.

Plaque build-up is a critical warning sign for possible future heart disease risk.

“We were surprised by the finding, mainly because we essentially think of exercise as medicine. And we’ve never thought of exercise as perhaps having an upper limit in terms of its cardiovascular benefit,” said study author Deepika Laddu.

She’s an assistant professor of physical therapy at the College of Applied Health Sciences at the University of Illinois at Chicago.

“What we saw is only an association, and we cannot say that high physical activity actually causes plaque build-up in white men,” she noted. “And we certainly do not mean to say that exercise is bad for you. In fact, it could perhaps be that white men already face a higher than average risk for plaque build-up than other men, and that exercise prevents this plaque from rupturing, which is when thing get bad. We just don’t know,” Laddu explained. “Much more research will be needed to understand what is really going on.”

At least one other expert agreed this doesn’t mean people should stop exercising. Dr. Gregg Fonarow, a professor of cardiology at the University of California, Las Angeles, said “it should be recognized that exercise alone cannot overcome other cardiovascular risk factors.” He added, “and it is vital to maintain health levels of blood pressure, cholesterol and body weight, as well as not smoke, even if one is engaging in regular rigorous physical activity.”

To explore how exercise might impact heart health over time, the investigators recruited nearly 3,200 white and black men and women. All enrolled when they were between the ages of 18 and 30, and all resided in one of four cities: Birmingham, Chicago, Minneapolis or Oakland.

The researchers followed the study volunteers from 1985 to 2011. During that time, participants self-reported their physical activity routines and showed up for at least three follow-up exams, which included CT scans to measure plaque build-up.

Friday, October 20, 2017

Ovarian Reserve Tests Fail to Predict Fertility

Tests that estimate ovarian reserve, or the number of a woman’s remaining eggs, before menopause, do not appear to predict short-term chances of conception, according to a National Institutes of Health-funded study of women with no history of infertility. The study appears in the Journal of American Medical Association.

“Women are born with a set number of eggs that gradually declines through the reproductive years,” said Ester Eisenberg, M.D., of the Fertility and Infertility Branch of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, which funded the study. “This study suggests that the testing for biomarkers of ovarian reserve does not predict the chances for conception in older women still of reproductive age.”

As a women ages and her egg supply declines, cells in the ovary secrete lower amounts of inhibin B and anti-Mullerian hormone, substances considered to be indicators of ovarian reserve. The ovaries also produce higher amounts of follicle stimulating hormone (FSH) in the days before ovulation. Although there is little research to support their use, tests for anti-Mullerian hormone are routinely offered in many fertility clinics on the assumption that women with a lower ovarian reserve would be less likely to respond to treatment. Moreover, home fertility tests of urinary FSH are commercially available.

The researchers enrolled 750 women from 30 to 44 years of age who had been attempting to conceive for three or fewer months. Women were ineligible to participate if they had known fertility problems, such as polycystic ovarian syndrome, tubal blockage or endometriosis. The women provided a urine and blood sample and checked for conception with home pregnancy test kits. The researchers statistically corrected for factors known to reduce fertility, such as smoking, recent use of oral contraceptives and obesity.

After six cycles of attempting to conceive, results did not differ significantly between women with low levels and normal levels of anti-Mullerian hormone – a 65% chance of conception, compared to a 62% change. Similarly, results were not statistically different after 12 cycles: 82% versus 75%.

Chances for conception also did not differ significantly according to high versus normal levels of FSH, with conception rates of 61% versus 62% after six cycles and 82% versus 75% after 12 cycles. The researchers found no association of inhibin B levels and conception after six cycles or 12 cycles.

Wednesday, October 18, 2017

Wisdom Wednesday: Iron Absorption from Oral Iron Supplements

Current guidelines to treat iron deficiency recommend daily provisions of serous iron divided through the day to increase absorption. However, daily dosing and split dosing might increase serum hepcidin and decrease iron absorption from subsequent doses. Our study aim was to compare iron absorption from oral iron supplements given on consecutive versus alternate days and given as single morning doses versus twice-daily split dosing.

Methods – Two prospective, open-label, randomized controlled trials were performed assessing iron absorption using (Fe)-labelled ferrous sulfate in iron-depleted (serum ferritin < 25 ug/L) women aged 18-40 years. In study 1, one group was given 60 mg iron on consecutive days for 14 day, and the other group was given the same doses on alternate days for 28 days. In study 2, the women were stratified by serum ferritin so that two groups with similar iron statuses could be formed. One group was given 120 mg iron and the other was given the dose split into two divided doses of 60 mg. The groups were crossed over to the other regimen after two weeks. The co-primary outcomes in both studies were iron bioavailability and serum hepcidin. Findings – In iron-depleted women, providing iron supplements daily as divided dosses increases serum hepcidin and reduces iron absorption. Providing iron supplements on alternate days and in single doses optimizes iron absorption and might be a preferable dosing regimen. My Take:
I dumbed this study down but left enough data to show just how a good randomized controlled study should be structured.

Despite an excellent format, I have some concerns with the study. First, the dosage was so high that absorption was probably reduced in all groups. I typically use 10 mg of iron taken once daily. Second, ferrous sulfate is a very poorly absorbed form of iron. I much prefer a food source product where the iron is organically bound. Of course, you can’t radioactively label organic iron, so it could never be tracked through the body like (Fe) labelled ferrous sulfate.

When iron in the diet fails to be absorbed, it ends up in the large intestine where it creates severe constipation. I can’t imagine that any of these women pooped during the trials!

Prior to the onset of constipation, the stool generally turns black from the presence of small amounts of iron. Clinically, I use constipation and a dark stool to titrate iron supplementation for maximum absorption.

As a side note, detecting iron is the stool is the basis of the occult blood test used to find GI bleeds. Iron intake is restricted for five days (no red meat, supplementation, etc.) then the fecal smear is performed on days 3, 4, and 5. It’s an inexpensive way to test the bowel in the presence of anemia of unknown cause.

The Bottom Line:
If you suffer from iron deficiency anemia (microcytic anemia) start with very low doses of iron and use a food source in lieu of ferrous sulfate. Based on this study, I will try supplementing alternate days to see if it improves the results of low dose iron supplementation.

Source: October 9, 2017 The Lancet

Monday, October 16, 2017

Uncontrollable Drug Prices

The same medication to prevent preterm birth can cost $200 – or nearly $11,000, a new study finds.

Harvard Medical School researchers found that use of a brand name and prepackaging was associated with a 5,000% increase in the cost of the synthetic hormone progestin.

They said the average per-pregnancy cost of a compounded, made-to-order form of the medication known as 17P was $206. That compared with $10,917 for a brand-name prepackaged version of the same medication.

“Everyone is talking about how to pay for health care, but few talk about why health care in the United States is so expensive. Uncontrollable drug prices are a major cause of this trend,” study co-author Andrew Beam said in a Harvard news release. He’s an instructor of biomedical informatics.

The two medications have the same active ingredients and are clinically interchangeable, according to the research team.

The investigators’ analysis of costs and pregnancy outcomes among more than 3,800 women treated with the drugs also found no statistically significant difference in the rate of preterm births – nearly 24% in the brand-name group and about 25% among women who received the compounded drug.

The researchers estimated that the annual cost of treating all medically eligible women with the brand-name version would be more than $1.4 billion, compared with $27.5 million for the compounded version.

“This case is emblematic of a systemic disorder that is not unique to one particular drug, class of drugs or manufacturer. There is no transparent and systematic link between the price, or cost, of a drug and its actual value or impact in terms of health and disease,” said study co-author Isaac Kohane, chair of the biomedical informatics department at Harvard.

Friday, October 13, 2017

Breast Cancer Linked to Bacterial Imbalances

In a newly published study, Cleveland Clinic researchers have uncovered differences in the bacterial composition of breast tissue of healthy women vs. women with breast cancer. The research team has discovered for the first time that healthy breast tissue contains more of the bacterial species Methylobacterium, a finding which could offer a new perspective in the battle against breast cancer.

Bacteria that live in the body, knows as the microbiome, influence many diseases. Most research has been done on the “gut” microbiome, or bacteria in the digestive tract. Researchers have long suspected that a “microbiome” exists within breast tissue and plays a role in breast cancer but it has not yet been characterized. The research team has taken the first step toward understanding the composition of the bacteria in breast cancer by uncovering distinct microbial differences in healthy and cancerous breast tissue.

“To my knowledge, this is the first study to examine both breast tissue and distant sites of the body for bacterial differences in breast cancer,” said co-senior author Craris Eng, M.D., Ph.D. chair of Cleveland Clinic’s Genomic Medicine Institute and director of the Center for Personalized Genetic Healthcare. “Our hope is to find a biomarker that would help us diagnose breast cancer quickly and easily. In our wildest dreams, we hope we can use microbiomics right before breast cancer forms and then prevent cancer with probiotics or antibiotics.”

Published online in Oncotarget on Oct. 5, 2017, the study examined the tissues of 78 patients who underwent mastectomy for invasive carcinoma or elective cosmetic breast surgery. In addition, they examined oral rinse and urine to determine the bacterial composition of these distant sites in the body.

In addition to the Methylobacterium finding, the team discovered that cancer patients’ urine samples had increased levels of gram-positive bacteria, including Staphylococcus and Actinomyces. Further studies are needed to determine the role these organisms may play in breast cancer.

Wednesday, October 11, 2017

Wisdom Wednesday: Stealth Bioburden

Traditionally, the bioburden is defined as the number of bacteria living on a surface that hasn’t been sterilized. This is a real concern in the hospital setting and attempts with antibacterial soaps have led to super bugs that are antibiotic resistant.

The stealth bioburden is an emerging term used to describe commensal bacteria in the digestive tract that may have adverse effects on our health.

Under healthy conditions, commensal bacteria are kept in check by the healthy bacteria (probiotics) that vastly outnumber the commensals. The GALT (gut associated lymphoid tissue) also plays a vital role in analyzing the microbiome and transmitting data to the thymus.

Dysbiosis, the term used to describe an imbalance of the microbiome, is most commonly caused by the use of antibiotics. However, chemotherapy and radiation therapy have similar effects. Food poisoning and drinking contaminated water are other common sources.

Virtually all cases of “intestinal flu” are mild cases of food poisoning but are seldom diagnosed. The body responds by purging (diarrhea and/or vomiting) for a day or longer, then we gradually return to normal.
But do we really return to normal?

The stealth bioburden is that ongoing stress from commensal bacteria overgrowth that disrupts normal digestion and elimination. For some, it results in intermittent constipation and/or diarrhea. If it continues unabated, you might be diagnosed with IBS (irritable bowel syndrome).

For most, however, we are told that whatever bowel function we have is “normal for you”.
Laboratory evaluation of the stealth bioburden is in its’ infancy. We can only identify about 20% of the bowel flora using DNA analysis. Although this technology holds great promise for the future, the applications are currently limited.

Digestive stool analysis can readily identify many commensal bacteria. However, it is difficult to determine, which, if any of them are truly a bioburden. Measuring the immune response of the GALT is valuable in determining whether the immune system is unable to cope or is overtly responding to the presence of commensal bacteria. Zonulin, diamine oxidase (DAO), histamine, IgA, IgG, and IgM can all be measured in the gut to assess the immune response.

Monday, October 9, 2017

Obesity Linked to 13 Types of Cancer

A new study suggests that being obese or overweight was associated with cancer cases involving more than 630,000 Americans in 2014, and this includes 13 types of cancer.

“That obesity and overweight are affecting cancers may be surprising to many Americans. The awareness of some cancers being associated with obesity and overweight is not yet widespread,” Dr. Anne Schuchat, CDC deputy director, said during a midday media briefing.

The 13 cancers include brain cancer; multiple myeloma; cancer of the esophagus; postmenopausal breast cancer; cancers of the thyroid, gallbladder, stomach, liver, pancreas, kidney, ovaries, uterus and colon, the researchers said.

Speaking at the news conference, Dr. Lisa Richardson, director of CDC’s Division of Cancer Prevention and Control, said early evidence indicates that losing weight can lower the risk for some cancers.

According to the new report for the CDC and the U.S. Cancer Institute, these 13 obesity-related cancers made up about 40% of all cancers diagnosed in the United States in 2014. Although the rate of new cancer cases has decreased since the 1990s, increases in overweight and obesity-related cancers are likely slowing this progress, the researchers said.

Excluding colon cancer, the rate of obesity-related cancer increased by 7% between 2005 and 2014. During the same time, rates of non-obesity-related cancers dropped, the findings showed.

Friday, October 6, 2017

Prenatal Multivitamins Linked to Lower Autism Risk

Analyzing more than a quarter-million mother-child pairs in Sweden, researchers found a link – but not cause and effect proof – between multivitamin use and risk of developing autism.

“Multivitamin use with or without added iron or folic acid was associated with a lower likelihood of child autism with intellectual disability, compared with mothers who did not use supplements,” said lead researcher Elizabeth DeVilbiss. The odds of autism in the multivitamin group were 30% lower, added DeVilbiss, a Ph.D. graduate in epidemiology and biostatistics at Drexel University’s Dornsife School of Public Health in Philadelphia.

Autism spectrum disorder includes a range of conditions that affect social interaction, communication, interests and behavior. It’s estimated that about 1 in every 68 people in the United States has some form of autism, boys more often than girls.

Experts believe autism is caused by genetic and environmental factors. It most likely starts in the womb, and the mother’s diet during pregnancy might have an influence, DeVilbiss said. However, DeVilbiss said it’s too early to recommend multivitamins specifically for lowering autism risk.

Because the study was observational, it’s possible that women who take a multivitamin during pregnancy might engage in other healthy behaviors that account for the reduced autism risk, DeVilbiss said.

For the study, DeVilbiss and her colleagues collected data on 273, 107 mother and child pairs form Stockholm. The children were born between 1996 and 2007 and were followed at least to age 4 and to 15 in some cases. Mothers reported their use of folic acid, iron and multivitamin supplements at their first prenatal visit. Cases of child autism spectrum disorder were identified using national registers.

Wednesday, October 4, 2017

Wisdom Wednesday: Could Skipping Breakfast Feed Heart Disease?

Middle-aged adults who routinely skip breakfast are more likely to have clogged heart arteries than those who enjoy a big morning meal, a new study finds.

The findings are the latest to link breakfast to better heart health. They suggest that people who eat breakfast – especially a hearty one – are less likely to harbor plaques in their arteries.

Plaques are deposits of fat, calcium and other substances that can build up in arteries, causing them to harden and narrow – a condition called atherosclerosis. Atherosclerosis can lead to heart attacks, strokes and other complications.

“It’s not that you skip breakfast, you get plaques,” said senior researcher Jose Penalvo, of Tufts University’s Friedman School of Nutrition Science and Policy in Boston. But, he said, there are several reasons that forgoing the morning meal could contribute to the risk of atherosclerosis.

For many people, skipping breakfast is part of a “cluster” of bad habits, said Penalvo. These people tend to eat out a lot, and opt for nutritionally dubious convenience foods, for instance. On top of that, Penalvo said, skipping breakfast may have negative effects on appetite-regulating hormones, blood sugar and insulin (a hormone that regulates blood sugar).

Prior studies have shown that breakfast fans are less likely to be obese or have diabetes or heart disease. But the current study actually used ultrasound to screen middle-aged adults for “subclinical” atherosclerosis – early plaque buildup that is not causing any symptoms.

The study included more than 4,000 adults ages 40 to 54 from Spain. Three percent were chronic breakfast-skippers, while 27% regularly had a big breakfast. That meant they ate more than 20% of the daily calories at their morning meal. Most people – 70% - ate a relatively low-calorie diet.

Nearly 75% of breakfast-skippers showed plaque buildup. That compared with 57% of people who ate a big breakfast, and 64% of those who favored a light one.

Monday, October 2, 2017

Genetic Testing May Help Make Blood Thinner Safer

Warfarin (Coumadin, Jantoven) is often prescribed to prevent life-threatening blood clots in high-risk patients. However, a patient’s genes can influence how warfarin is processed in the body. Too little warfarin will not prevent blood clots while too much can trigger internal bleeding, the researchers explained.

Warfarin is “a widely used anticoagulant, but it causes more major adverse events than any other oral drug. Thousands of patients end up in the emergency department or hospital because of warfarin-induced bleeding. But we continue to prescribe it because it is highly effective, reversible and inexpensive,” said study first author Dr. Brian Gage. He is a professor of medicine at Washington University School of Medicine in St. Louis.

The researchers said they found that by looking for variants in three genes, it’s possible to make warfarin therapy safer.

Variants in one gene affect vitamin K recycling (vitamin K is needed for blood clotting). Variants in another gene affect warfarin sensitivity. And variants in the third gene affect warfarin metabolism in the liver and can cause an overdose if the dose is not adjusted quickly enough, the researchers said.

The study included about 1,600 people 65 and older at high risk for blood clots after undergoing hip or knee replacement surgery. They were randomly assigned to receive either warfarin dosing based on standard clinical factors such as age, height and weight. Or dosing based on those clinical factors plus variants in the three genes.

Friday, September 29, 2017

High, Low Levels of Magnesium Linked to Dementia Risk

Having magnesium levels that are too high or too low may put you at risk for Alzheimer’s and other dementias, Dutch researchers report.

In a study of more than 9,500 men and women, the highest or lowest levels of magnesium appeared to increase the chances for dementia by as much as 30 percent.

“At this moment, magnesium levels are not routinely measured in daily clinical practice,” said lead researcher Dr. Brenda Kieboom, of Erasmus University Medical Center in Rotterdam. “If our study results are replicated, magnesium levels could be used to screen for dementia, especially in people at risk for low magnesium levels.”

Kieboom said she also wants to study whether low magnesium levels also associate with a decline in mental function over time. “Mental function can be seen as a precursor stage of dementia, and if we find similar associations with dementia this will support our theory for a causal association,” she said.

“We already found that proton pump inhibitors [acid reflux drugs such as Nexium and Prilosec] are associated with a higher risk for abnormally low magnesium levels, but we continue looking into other drugs,” she said.

Those at risk for low levels of magnesium include people who use proton pump inhibitors or diuretics, or people who have a diet low in magnesium, Kieboom said.

Wednesday, September 27, 2017

Wisdom Wednesday: Death Risk from Triathlons May Be Higher Than Thought

Could some triathlon participants be pushing themselves too hard? New research suggests the odds that an athlete will die during these tests of endurance are higher than previously believed.

“We identified a total of 135 deaths and cardiac arrests in the U.S. triathlons from the inception of the sport in 1985 through 2016,” said study lead author Dr. Kevin Harris. Most were due to undiagnosed heart issues.

“The vast majority of the deaths occurred in the swim,” added Harris, a cardiologist with the Minneapolis Heart Institute at Abbott Northwestern Hospital.

Researchers also discovered that race-related fatalities most often involved middle-aged or older men. And the investigators found that sudden death, cardiac arrest, and trauma-related death during triathlons are not rare.

Overall, risk of dying during a triathlon was 1.74 for every 100,000 athletes – the equivalent of about five triathlete deaths a year, investigators found. This is higher than previous estimates.

“To put this in context, the risk is about twice as high as that reported in marathon races,” Harris said. Also, “compared to populations of athletic individuals, the risk for a single triathlon seems to exceed the annual risk for recreational athletes. Still, in absolute terms the fatality risk among triathletes remains low, Harris said.

As to what might explain the findings, Harris pointed to the “acute stress” of triathlon participation. “It is important to realize that an athlete may be physically fit but have severe underlying cardiovascular disease that becomes manifest only under very significant stress,” he noted. Harris suggested that male triathletes over 40 review their risk factors for coronary disease when considering entering a race.

Of the 135 fatalities, cardiac arrest and sudden death were the most common causes: 90 occurred during the swim portion, 15 while running and 7 while bicycling. Another 15 deaths during biking were attributed to traumatic injury, and 8 competitors died during post-race recovery, according to the report.

Monday, September 25, 2017

Acid Reflux? Try Going Vegetarian

A mostly vegetarian diet may provide relief similar to widely used medications for people with acid reflux, a new study suggests.

The study looked at close to 200 patients at one medical center who had been diagnosed with laryngopharyngeal reflux.

It’s a condition where stomach acids habitually back up into the throat, and it’s distinct from the much better-known gastroesophageal reflex disease (GERD) – or what most people call heartburn.

People with laryngopharyngeal reflux usually don’t have heartburn, explained Dr. Craig Zalvan, the lead researcher on the new study. Instead, they have symptoms like hoarseness, chronic sore throat, persistent coughing, excessive throat clearing and a feeling of a lump in the throat.

Still, the problem is often treated with GERD drugs known as proton pump inhibitors (PPIs). PPIs include prescription and over-the-counter drugs like Prilosec, Prevacid and Nexium, and they rank among the top-selling medications in the United States.

PPIs do help some people with laryngopharyngeal reflux, said Zalvan. He’s chief of otolaryngology at Northwell Health System’s Phelps Hospital, in Sleepy Hollow, N.Y. And Zalvan, himself, used to prescribe them regularly. However, it became clear that the medications were not effective for many patients, Zalvan said. At the same time, he noted, studies began raising concerns that PPIs are not as safe as thought.

Zalvan encouraged patients to go 90% plant based – eating mainly vegetables, fruits, legumes, and whole grains and nuts. Meat and dairy were to be limited to two or three modest servings per week. In addition, Zalvan gave his patients the standard reflux-soothing advice to avoid coffee, tea, alcohol and fried or fatty foods.

Friday, September 22, 2017

The Best Way to Diagnose a Food Allergy

Diagnosing a food allergy isn’t always simple, but the best way to do it is through an oral food challenge, according to a new study.

“It’s important to have an accurate diagnosis of food allergy so an allergist can make a clear recommendation as to what foods you need to keep out of your diet,” said study senior author and allergist Dr. Carla Davis. She is an associate professor of pediatrics at Baylor College of Medicine in Houston.

During an oral food challenge, patients are asked to eat a very small amount of a suspected allergen while under the close supervision of a specially trained doctor, called an allergist. This doctor will evaluate the person for signs of an allergic reaction.

Researchers who analyzed more than 6,300 oral food challenges found these tests were safe and caused very few people to have a serious allergic reaction. Most of these tests involved children and teens younger than 18.

Of these cases, 14% resulted in a mild to moderate reaction that involved just one part of the body, such as a skin rash. The researchers noted that 2% resulted in very severe reactions that affected multiple body systems (anaphylaxis).

The results were published Sept. 7 in the journal Annals of Allergy, Asthma and Immunology.

Wednesday, September 20, 2017

Wisdom Wednesday: Do Fewer Nightly Dreams Mean Higher Dementia Risk in Seniors?

Seniors who spend less time each night in the dream stage of sleep may be more likely to succumb to dementia as they age, new research suggests.

Known as rapid eye movement (REM) sleep, this critical phase “occurs in intervals throughout the night, and is characterized by more dreaming and rapid eye movements,” explained study author Matthew Pase. He is a senior research fellow with Swinburne University of Technology in Australia, and a visiting researcher in the department of neurology at Boston University School of Medicine.

“We found that persons experiencing less REM sleep over the course of a night displayed an increased risk of developing dementia in the future” Pase said. He noted that for every 1% drop in REM sleep, the seniors in his study was their dementia and Alzheimer’s disease go up by about 9%.

While prior research has pointed to the REM-dementia link, the current investigation is the first to link less REM sleep to a higher risk for developing dementia up to 18 years down the road. And that, said Pase, means that “changes in REM sleep may not simply be a consequence of dementia,” but rather a contributing cause.

Pase’s study focused on 321 men and women aged 60 and up (average age 67) who had participated in the Framingham Heart Study (FHS) between 1995 and 1998. The research team first tracked the sleep cycle of the men and women over the course of a single night. All the patients were then tracked for signs of dementia for up to 19 years (12 years, on average). Ultimately 32 participants developed dementia. Twenty-four of those people developed Alzheimer’s.

Monday, September 18, 2017

Could Folic Acid Fight a Cause of Autism?

By taking folic acid around the time of conception, mothers-to-be may reduce their child’s risk of pesticide-related autism, a new study suggests.

“We found that if the mom was taking folic acid during the window around conception, the risk associated with pesticides seemed to be attenuated,” said study first author Rebecca Schmidt.

“Mothers should try to avoid pesticides. But if they live near agriculture, where pesticides can blow in, this might be a way to counter those effects,” said Schmidt. She is an assistant professor of public health sciences at the University of California, Davis.

It’s estimated that one in 68 U.S. children has an autism spectrum disorder, which can range from mild to severe. There is no single cause, but research suggests a combination of genetic and environmental influences plays a role, according to the U.S. National Institutes of Health.

The new study included about 300 children aged 2 to 5 with autism and 220 without the developmental disorder. Children whose mothers took 800 or more micrograms of folic acid (the amount in most prenatal vitamins) had a much lower risk of developing autism, even when their mothers were exposed to household or agricultural pesticides, the researchers said.

Autism risk was higher among children whose mothers were repeatedly exposed to pesticides or whose mothers had low folic acid intake and exposure to agricultural pesticides between three months preconception and three months afterward, the findings showed.

Folic acid is the synthetic form of vitamin B9, found in supplements and fortified foods. While taking it reduced the associated risk of pesticide-related autism in children, it did not entirely eliminate it, the report noted.

Friday, September 1, 2017

Could Common Vitamin Supplements Raise Lung Cancer Risk?

Men, and especially male smokers, appear to be more likely to develop lung cancer if they take high doses of vitamins B6 and B12, new research suggests. For men taking these vitamin supplements, the risk of lung cancer was nearly doubled. For men who smoked, the risk was between three and four times higher, the study found.

“High-dose B6 and B12 supplements should not be taken for lung cancer prevention, especially in men, and they may cause harm in male smokers,” said study lead author Theodore Brasky. He is a research assistant professor at Ohio State University.

Most people in the United States get enough vitamin B6 through their diets, according to the U.S. National Institutes of Health (NIH). Some people with certain health conditions may need supplements.

As for vitamin B12, the NIH reports that most Americans get enough from their diet. But some groups – such as older people and vegetarians – may be deficient and need supplements. The vitamin may also cause interactions with medications.

Dietary sources of vitamin B6 and B12 include fortified cereals and foods than are high in protein.
The new study included more than 77,000 adults, aged 50 to 76, in Washington State. The participants were recruited from 2000 to 2002, and answered questions about their vitamin use over the previous 10 years.

The researchers found that just over 800 of the study volunteers developed lung cancer over an average follow-up of six years. The study found no sign of a link between folate and lung cancer risk. And vitamin B6 and B12 supplements didn’t seem to affect risk in women.

However, “we found that men who took more than 20 mg per day of B6 averaged over 10 years had an 82% increased risk of lung cancer relative to men who did not take supplemental B vitamins from any source,” Brasky said. Men who smoked at the beginning of the study period and consumed high levels of the B vitamins were 3 to 4 times more likely to develop lung cancer, he added.

Wednesday, August 30, 2017

Wisdom Wednesday: How Sate Is Your Drinking Water?

Even if local health officials say it’s safe, cloudy drinking water may have the potential to cause vomiting and diarrhea, a new research review finds.

Researchers looked at past North American and European studies exploring the link between water cloudiness, or turbidity, and tummy troubles. “More than 10 studies found a link between water turbidity and acute gastrointestinal illness incidence,” said researcher Anneclaire De Roos. She is an associate professor at Drexel University’s Dornsife School of Public Health in Philadelphia.

Waterborne germs such as norovirus, Giardia and Cryptosporidium can cause gastrointestinal illness. The researchers estimate that water systems in the United States may cause more than 16 million cases of stomach distress.

Cloudiness in water is caused by undissolved particles, or it could be evidence of runoff containing not just sediment but also harmful germs, the researchers said. In the review, De Roos said, “the association between turbidity and acute gastrointestinal illness was found in cites with relatively high turbidity levels, often in unfiltered drinking water supplies.”

That wasn’t a surprise. However, “the findings that go against the conventional wisdom are the associations between turbidity and acute gastrointestinal illness that were seen at very low levels of turbidity, levels lower than the regulatory limits,” she said.

Monday, August 28, 2017

Alzheimer’s Prevention: A Summary of What We Know

Alzheimer disease (AD) prevalence in the United States currently exceeds 5 million, and the Alzheimer’s Association estimates a US prevalence of 16 million by the year 2050 unless an effective treatment is developed. Increasing age is still the leading risk factor for AD, with a prevalence of 42% by age 82 years. Other nonmodifiable risk factors include female sex, positive family history, and presence of the apolipoprotein E 4 allele.

At present, only four FDA-approved medications are available for memory and behavioral AD symptoms. Disease-modifying treatment trials have been unsuccessful, although several new trials are underway and research continues. Prevention strategies are therefore essential and are now facilitated by advances in diagnostic criteria, biomarker development, and greater understanding of the biophysiologic underpinnings of AD.

Risk-factor prevention should target diabetes mellitus and insulin resistance, obesity, metabolic syndrome, hypertension, hypercholesterolemia, cerebrovascular disease, depression, psychological and physiologic stress, traumatic brain injury, sleep-disordered breathing, smoking, alcohol abuse, high blood pressure, renal disease, alcohol and tobacco use, high cholesterol, coronary heart disease, sedentary life style, and diet. These potentially modifiable risk factors, when combined, account for more than 50% of AD risk, based on observational studies, and many of these risk factors do not appear to affect amyloid tau proteins. In sporadic and genetic forms of AD, pharmacologic trials of antiamyloid therapies are ongoing.

Modifiable factors appearing to protect against AD include cognitive reserve and mental activity, educational attainment and lifelong learning, cognitive leisure activities, physical activity and exercise, social engagement, mindfulness and wellness activities, optimism and purpose in life, healthy diet and omega-3 intake. A review of 19 studies suggests that certain brain-stimulating activities may help reduce AD risks. These include crossword puzzles, card games, computer use, arts or crafts, taking classes, group discussions, and listening to music.

Depending on the typed of exercise and its intensity, physical activity may lower AD risk by up to 65%. Underlying mechanisms may include reduction in blood vessel disease, better pulmonary function, increased cell survival, and anti-inflammatory effects.

Friday, August 25, 2017

FDA May Limit ‘Risk Info’ in Direct-to-Consumer TV Drug Ads

The U.S. Food and Drug Administration may shorten the list of caveats for drugs you see advertised on television.
Prescription drug makers must now mention all benefits and risks in direct-to-consumer advertising, presenting viewers with a litany of potential harms, both major and minor. But a new approach being considered could trim those lists to feature only the most serious and potentially fatal side effects, the FDA said Friday.

The “FDA’s own research on broadcast TV drug advertisements suggests that a more targeted method for delivering risk information may lead to better retention of those risks,” FDA Commissioner Dr. Scott Gottlieb said in an agency news release.

To that end, “the agency is exploring the usefulness of limiting the risks in the major statement for most drug advertisements to those that are severe [life-threatening], serious or actionable, couple with a disclosure to alert consumers that there are other product risks not included In the advertisement,” Gottlieb said.

While this might spare TV viewers lengthy lists of relatively insignificant physical complaints, it might also deprive them of critical information. To come to the best solution, the FDA is asking consumers, doctors and others to comment on which risk information is most helpful in TV and other broadcast ads.

Dr. Nachum Katlowitz, director of urology at Staten Island University Hospital in New York City, thinks it’s time to reconsider the advertising requirements. “In a one minute direct-to-consumer advertisement, they spend 55 seconds in a kind, clear, pleasing voice discussing all the wonderful things this product will do to help your life,” said Katlowitz. “Then, in the last five seconds in a rapid, audible but difficult to understand monotone voice, they discuss the risks and end with, ‘Ask your doctor.’”

Wednesday, August 23, 2017

Wisdom Wednesday: When Stress Hormone Falters, Your Health May Suffer

Steady daytime levels of the stress hormone cortisol are associated with serious health problems, such as inflammation, obesity and cancer, researchers say.

“Cortisol is naturally high in the morning to help perk you up, and it decreases into the evening,” said study lead author Emma Adam. She is a professor of human development and social policy at Northwestern University.

“The loss of this cycle – or the lack of variation of cortisol – is what is associated with negative health outcomes in our study,” Adam said in a university news release. The researchers suspect that chronic stress may be behind the less variable cortisol levels. They call it “stress-related circadian dysregulation.”

For the research, the study team reviewed data from 80 studies. The investigators looked specifically at 12 health problems and found that 10 seemed associated with the loss of variation in cortisol levels.

“While inflammation and the immune system dysfunction had the strongest associations, fatigue, cancer, depression, and obesity were all worse in people who had less variation in their cortisol,” Adam said.

The findings suggest that restoring daily cortisol rhythms could benefit people’s health. “It’s the righting of the rhythms that are important, more so than the righting of levels,” the researchers wrote.

Adopting healthy habits – such as regular exercise and adequate sleep – are important steps in restoring strong daily cortisol rhythms, Adam and her colleagues said.

Monday, August 21, 2017

Skeletons Give Clues to Americans’ Rising Arthritis Rates

Rates of knee osteoarthritis have doubled in the United States since the 1940s, but it’s not just because Americans are living longer and weight more, a new study suggests.

To come to this conclusion, Harvard University researchers examined more than 2,000 skeletons from across the Unites States.

“We were able to show, for the first time, that this pervasive cause of pain is actually twice as common today as even in the recent past. But the even bigger surprise is that it’s not just because people are living longer or getting fatter, but for other reasons likely related to our modern environments,” said study first author Ian Wallace.

Wallace is a post-doctoral fellow in the lab of senior study author Daniel Lieberman, a professor of biological sciences at Harvard University.

The researchers are now working to find out what’s causing the increase. They said learning more about knee osteoarthritis is important not only because it affects a third of Americans over age 60, but because it is responsible for more disability than almost any other musculoskeletal disorder.

“Wouldn’t it be great if people could live to be 60, 70 or 80 and never get knee osteoarthritis in the first place?” Lieberman said in a Harvard news release. He noted that the disease is “almost entirely untreatable apart from joint replacement,” and once someone has it, it creates a vicious cycle. “People become less active, which can lead to a host of other problems, and their health ends up declining at a more rapid rate,” Lieberman explained.

For the study, published Aug. 14 in the Proceedings of the National Academy of Sciences, the authors examined research spanning more than 6,000 years of human history to search for a tell-tale sign of osteoarthritis.

Friday, August 18, 2017

Benefits and Safety of Gabapentinoids in Chronic Low Back Pain

Chronic Low Back Pain (CLBP) is very common, with a lifetime prevalence between 51% and 80%. In majority, it is nonspecific in nature and multifactorial in etiology. Pregabalin (PG) and Gabapentin (GB) are gabapentinoids that have demonstrated benefit in neuropathic pain conditions. Despite no clear rationale, they are increasingly used for nonspecific CLBP. They necessitate prolonged use and are associated with adverse effects and increased cost. Recent guidelines from the National Health Service (NHS), England, expressed concerns on their off-label use, in addition to the risk of misuse. We aimed to assess the effectiveness and safety of gabapentinoids in adult CLBP patients.

Methods - Electronic databases of MEDLINE, EMBASE, and Cochrane were searched from their inception until December 20th, 2016. We included randomized control trials reporting the use of gabapentinoids for the treatment of CLBP of >3 months duration, in adult patients. Study selection and data extraction was performed independently by paired reviewers.

Results – Out of 1,385 citations, eight studies were included. Based on the interventions and comparators, studies were analyzed in 3 different groups. GB compared with placebo showed minimal improvement of pain in three studies. Three studies compared PG with other types of analgesic medication and showed greater improvement in the other analgesic group. Studies using PG and an adjuvant were not pooled due to heterogeneity, but the largest of them showed no benefit of adding PG to tapentadol. There were no deaths or hospitalizations reported. Compared with placebo, the following adverse events were more commonly reported with GB: dizziness, fatigue, difficulties with mentation and visual disturbances.

Conclusions and relevance – Existing evidence on the use of gabapentinoids in CLBP is limited and demonstrates significant risk of adverse effects without any demonstrated benefit. Given the lack of efficacy, risks, and costs associated, the use of gabapentinoids for CLBP merits caution. There is need for large high-quality trials to more definitively inform this issue.

Wednesday, August 16, 2017

Wisdom Wednesday: When You Hear Hoof Beats, Don’t Look for Zebras

Many years ago an MD I worked with gave me this answer when I inquired about the possibility of some exotic disease in a common patient. The exact quote was “Oh Bill, when you hear hoof beats, don’t look for zebras, it’s usually horses.”

My response was that during college I lived along the Hillsborough River in Tampa. Every morning, driving to class at USF, I passed Bush Gardens and saw lots of zebras.

Zebras do occur in everyday practice. They just don’t occur every day. However, as a primary care physician, it is my responsibility to see the tell-tale ‘stripes’ and act accordingly.

The patient that comes in with acute low back pain is almost always a horse. But if she has a history of breast cancer or he has a history of prostate cancer, they might be a zebra. Metastasis from breast or prostate loves bone, especially the low back. I am responsible for picking up on that stripe even if the patient doesn’t give me the history. That’s because it’s my responsibility to ask.

I don’t have to diagnose the cancer or treat it, but I have to make the appropriate referral. I may decide to run further testing to make a more educated referral or even co-treat. What I cannot do is delay proper diagnosis or medical treatment.

Diagnosing zebras is also an issue. If I, or any other physician, suspect a particular disease, you cannot tell the patient they have that disease without running the appropriate diagnostic testing. You tell them that you suspect a possible pathology. If pressed, you give them a differential that includes a few possible disease processes.