Monday, January 30, 2017

Is Running Bad for Your Knees?

It is commonly known that running can leave you sore and swollen. However, a new study suggests running might actually reduce inflammation in joints.

“It flies in the face of intuition,” said study co-author Matt Seeley, an associated professor of exercise sciences at Brigham Young University in Provo, Utah. “This idea that long-distance running is bad for your knees might be a myth.”

Seeley and his colleagues reached their surprising conclusion after analyzing the knee joint fluid of several healthy men and women between the ages of 18 and 35. The researchers looked for signs of inflammation in chemical markers before and after a 30-minute run and found little difference.

“What we now know is that for young healthy individuals, exercise creates an anti-inflammatory environment that may be beneficial in terms of long-term joint health,” lead author Robert Hyldahl said in a university news release. Hyldahl is an assistant professor of exercise science at BYU.

The researchers said the study suggests running could actually delay development of degenerative joint diseases like osteoarthritis.

“This study does not indicate that distance runners are any more likely to get osteoarthritis than any other person,” Seeley said. “Instead, this study suggests exercise can be a type of medicine.”

Friday, January 27, 2017

Weight Loss May Ease Psoriasis Symptoms

Danish researchers are reporting that obese people with the skin condition who lose 10-15% of their weight may see significant and lasting improvement in their symptoms.

The study participants lost an average of 33 pounds over 16 weeks. A year later, those who were still about 22 pounds below their weight from the start of the study maintained their improvement in psoriasis symptoms and quality of life, the study authors said.

“Psoriasis is more than just a skin condition,” said Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York City. Increased weight can stress the heart and other organs, and that stress can trigger psoriasis, she said.

“We know that weight and psoriasis together and independently increase the risk of high blood pressure and heart disease and diabetes. Psoriasis is an inflammatory condition – it’s not just a skin condition – it can affect any organ,” Day added.

Foods that make you gain weight can also be inflammatory, and since stress can make people eat more, that can trigger psoriasis. When you have increased weight, you also have more stress on major organs, which can also cause a cascade of effects that lead to psoriasis symptoms, Day explained.

The report was published recently in the American Journal of Clinical Nutrition.

Psoriasis is a chronic disease that is characterized by red, itchy and scaly patches of skin. The severity of the condition varies from person to person.

Wednesday, January 25, 2017

Wisdom Wednesday: The Urine Analysis

This is the last blog of my series on yearly laboratory testing. The previous blogs have all been about analysis of the blood. Today we focus on the urine.

Urine is a waste product that can provide a lot of information about metabolism in the body. It’s much like analyzing the exhaust from an automobile to see how well the engine is running.

The specific gravity measures the weight of the urine as compared to water. The normal range is 1.005 – 1.030. Pure water is 1.000. Levels below 1.005 indicate hyperhidrosis, above 1.030 dehydration.

The pH measures the relative acidity or alkalinity. The normal range is 5.0 – 7.5. Again, water is the reference with a neutral pH of 7.0. If the urine pH is above 7.5 it is too alkaline. If it is below 5.0, then it’s too acidic. Some bacterial infections like an acid environment, some like it alkaline. The use of cranberry juice for a UTI (urinary tract infection) is appropriate when the pH is high as the cranberry juice will lower the pH. However, use when the pH is below 5.0 will just support the acid-loving infection.

Normally the urine is clear in appearance and yellow in color. The presence of blood, WBCs, nitrates, or other particles can cloud the urine or change the color. If the urine is a dark yellow and the specific gravity is high suspect dehydration. You should monitor your own urine color for signs of dehydration as well.

There are a variety of chemical compounds that are evaluated routinely. A trace of protein is acceptable but there should be no glucose, ketones, or occult blood evident. Small amounts of urobilinogen are also acceptable. Nitrates are the result of bacterial degradation and also should not be seen.

If all of the parameters noted above are normal then the urine analysis is complete. However, if enough abnormalities are found, then a microscopic analysis is performed. This looks for bacteria, cells, and crystals.

Monday, January 23, 2017

More Signs Mediterranean Diet May Boost Your Brain

Researchers in Scotland examined the brain volume of hundreds of older adults over three years. The investigators found that people who more closely followed the eating habits common in Mediterranean countries retained more brain volume compared to those who did not.

“Research is accumulating to show protective effects of the Mediterranean diet on normal cognitive decline, dementia and Alzheimer’s disease,” said study leader Michelle Luciano, of the University of Edinburgh.

The Mediterranean diet is an eating style that emphasizes fruits, vegetables, olive oil instead of butter, beans and cereal grains, such as wheat and rice. Moderate amounts of fish, dairy and wine are included, while red meat and poultry are limited.

Experts know that with age, the brain shrinks and brain cells are lost. This can affect learning and memory, Luciano said.

“In our study, age had the largest effect on brain volume loss,” Luciano noted. However, “the effect of the Mediterranean diet was half the size of that due to normal aging,” she said. She considers that finding impressive.

The combination of foods may protect against factors such as inflammation and vascular disease, which can cause brain shrinkage, she added.

For the study, Luciano’s group collected dietary information form almost 1,000 Scots, about age 70 and free of dementia. More than half had a brain scan at age 73. The scans measured overall volume, gray matter and the thickness of the cortex – the brain’s outer layer.

Three years later, 401 study participants returned for another measurement.

Friday, January 20, 2017

Prices Skyrocket on Drugs Widely Used by Seniors

The prices of brand-name drugs used by many old Americans rose nearly 130 times faster than inflation last year, a new study reports.

“This new report once again highlights the high and unrelenting price increases that are shockingly common in the pharmaceutical market,” said Debra Whitman. She is chief public policy officer at AARP, a nonprofit organization focused on social welfare issues.

“What’s particularly remarkable is that these incredibly high price increases are still occurring in the face of the intense public and congressional criticism of prescription drug pricing practices,” Whitman said in an AAPR news release.

The researchers examined the prices of 268 brand-name prescription drugs widely used by seniors, including 49 in drug categories that are used to treat common and often chronic conditions, such as high blood pressure, high cholesterol and diabetes.

The average older person takes 4.5 prescription drugs a month. This means that current average yearly drug costs could be as much as $26,000, the researchers suggested.

The average median income of Medicare beneficiaries is $24,150.

The drug prices in the report are the total costs, and may not represent the actual out-of-pocket costs that a Medicare patient would pay at the pharmacy, the report authors noted.

Of the 268 drugs included in the report, 97% had retail price increases in 2015. Seven had average price increases of more than 50%. Five of the six drugs with the highest price increases were marketed by Valeant Pharmaceuticals. The price of the company’s anti-anxiety drug Ativan rose of 2,800% between 2006 and 2015, the study authors said.

Wednesday, January 18, 2017

Wisdom Wednesday: Coronary Risk Assessment

Most PCP (primary care physicians) and too many cardiologists prescribe statin drugs based on the total cholesterol and LDL levels. However, there are a couple of additional lab tests that can really define your cardiac risk factors. Three of these tests, the CRP, fibrinogen activity and homocysteine are included in my routine testing. The fourth, the L(p)a I run when I suspect that my patient’s elevated cholesterol is genetic (familial hypercholesterinemia).

The high-sensitivity C-reactive protein (CRP) measures inflammatory proteins in the blood. It is fairly specific for artery inflammation but dental issues and other vascular inflammatory conditions can also elevate the test. As I have reviewed in many previous blogs, artery inflammation is the real trigger for cardiovascular disease.

The normal range for CRP is 0.0 – 3.0, but levels less than 1.0 indicate low future risk of a cardiovascular event. Statin drugs actually do lower CRP and, in fact, that is why they do reduce the risk of CVA slightly. However, I believe there are better ways to lower CRP without the potential side effects associated with statin drugs.

Nattokinase, a protein extract from Japanese fermented soy, is excellent at reducing the CRP. It was discovered in 1980 by Dr. Sumi who looked at 173 different foods that seemed to reduce clots in the circulatory system. Generally, two capsules per day for three months will bring the CRP within medical norms.

Fibrinogen is a protein necessary for clot formation. The fibrinogen activity test is most commonly run to evaluate bleeding disorders. The normal range is 193-507 mg/dL. It’s levels below 193 that are associated with delayed clotting. However, levels above 507 are associated with cardiovascular disease. There is no known medical treatment to lower fibrinogen but my clinical experience has been that treating the other factors often results in a drop in the fibrinogen activity as well.

Homocysteine is in intermediate metabolite in the sulfur amino acid pathway. The normal levels are 0-15 umol/L. However, healthy levels are below 8. Homocysteine attaches to the LDL particle under the influence of fibrinogen, forming plaque against an inflamed artery wall when CRP is elevated. So medically, homocysteine is used to assess cardiovascular risk.

Proper conversion of homocysteine back to methionine is dependent on the active forms of folic acid and vitamin B12, so it is also used to evaluate potential folic acid and/or B12 deficiency. Conversion to cysteine is dependent on the active form of vitamin B6 yet the test is rarely considered an indication of B6 deficiency.

Monday, January 16, 2017

Fish Oil During Pregnancy May Cut Kids’ Asthma Risk

Women who take fish oil during their third trimester of pregnancy might cut their children’s risk of developing asthma by as much as one-third, a new clinical trial suggests.

The fish oil dose was high – with fatty acid levels that were 15 to 20 times more than the average American gets from food. But there were no significant side effects, according to lead researcher Dr. Hans Bisgaard. He’s a professor of pediatrics at the University of Copenhagen, in Denmark.

The study, published Dec. 29 in the New England Journal of Medicine, adds to evidence that fish oil may help ward of asthma.

In an editorial published with the study, Dr. Christopher Ramsden, a researcher with the U.S. National Institutes of Health, called the results “highly promising.” Still, he writes, “a note of caution is warranted.” Because the fil oil doses were high – 2.4 grams per day – research should look at whether the treatment has any negative longer-term effects, Ramsden said.

For the study, Bisgaard’s team randomly assigned 736 pregnant women to take either fish oil capsules or a placebo every day during the third trimester. The placebo capsules contained olive oil.

In the end, children in the fish-oil group were about one-third less likely to develop asthma or persistent wheezing – a sign of asthma in very young children. By the age of 5, nearly 17% were diagnosed with either condition, versus almost one-quarter of the children in the placebo group.

Dr. Jefry Biehler, chairman of pediatrics at Nicklaus Children’s Hospital in Miami stated that studies of other populations are needed as the study was done in Denmark, where fish intake is relatively high. “Women in the lower third of intake in Denmark are well above the average intake in the U.S.” Bisgaard said. “I expect a stronger effect in the populations that are inland, where fish is more unusual in the diet.”

Friday, January 13, 2017

Why Acne Can Strike Women After the Teen Years

Researchers from Italy who looked at 500 women uncovered some factors related to the risk of acne after the age of 25 – including a low intake of fruits and vegetables, high stress levels and a family history of adult acne.

“We see that people who have a diet of junk food tend to break out more,” said Dr. Debra Jaliman, an assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City.

Specifically, Jaliman said research has implicated foods with a high “glycemic index – which cause blood sugar to surge. Some high-GI foods include white bread and rice, chips and crackers, and sugary baked goods.

Similarity, Jaliman said, chronic stress takes a toll on overall health, and that could show up on the skin.

Over 80% of teenagers have bouts of acne. The good news is, most see their skin clear up after age 20, according to a team led by Dr. Luigi Naldi, of the Study Center of the Italian Group for Epidemiologic Research in Dermatology in Bergamo, Italy.

Still, anywhere from 20-40% of adults continue to have breakouts, the researchers added.

“Women tend to get adult acne more often than men,” Jaliman said. “It’s often due to changes in hormone levels and or hormonal imbalances.” But it’s not completely clear why some women continue to have acne, while others don’t.

The researchers found that women who ate fruits and vegetables, or fresh fish, on fewer than four days out of the week were more than twice as likely to have acne, compared to women who ate those foods more often.

The findings were published in the December issue of the Journal of the American Academy of Dermatology.

Wednesday, January 11, 2017

Wisdom Wednesday: Gycohemoglobin A1c

This blood test measures the percentage of RBCs (red blood cells) saturated with glucose. RBCs live about 120 days. During that span they can slowly be glycosylated by high levels of serum glucose. Assuming the average age of an RBC to be 60 days, this test reveals what your glucose levels have averaged over the course of the past two months. By comparison, the fasting glucose only measures the glucose level after eight or more hours for fasting, with no stress on glucose metabolism.

For the past several years the A1c has been used to monitor diabetics to see how effective they are managing their disease. However, in July of 2015, the A1c was established as the medical standard for diagnosing diabetes. This big step forward that has met with either resistance or indifference from the medical community as less than half of primary care physicians currently order this test for their patients.

The new standard recommends physicians begin to test patients who are obese between the ages of 40 and 45. I have been using this test on my patient population for several years. I do not restrict the test by age or weight status. Clinically, I have found that this test often begins to elevate in patients by their late 20’s, even when they are at ideal weight.

The normal range for the A1c is 4.8 to 5.6%. However, the diagnosis of diabetes is restricted to levels at or above 6.5%. A “well controlled diabetic” will have an A1c of 7% or less. Levels between 5.6 and 6.5% are considered “pre-diabetic”. Currently, over 50% of all Americans are estimated to be either diabetic or pre-diabetic and that percentage is still increasing.

In my office, anyone exhibiting symptoms of metabolic syndrome – central obesity, hypertension, high serum lipids, hypothyroidism, or insulin resistance – is a candidate for A1c testing, regardless of age. Additionally, using the QA (Quintessential Applications) protocol, if a patient tests for sesame seed oil to block prostaglandin inflammation (PG2) I also recommend an A1c. Clinically, over 90% of patients demonstrating a need for sesame seed oil have an elevated A1c. The remaining 10% typically have altered serum lipids or hypothyroidism.

Monday, January 9, 2017

Everyday Pain Relievers Linked to Hearing Loss in Women

Women who used ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) for six year or more were more likely to suffer hearing loss than those who used the pain relievers for a year or less, said researchers from Brigham and Women’s Hospital in Boston.

They found no significant association between long-term aspirin use and hearing loss.

“Although the magnitude of higher risk of hearing loss with analgesic use was modest, given how commonly these medications are used, even a small increase in risk could have important health implications,” study senior author Dr. Gary Curhan said in a hospital news release.

For the study, Curhan’s team analyzed data from more than 54,000 women, ages 48 to 73, in the Nurses’ Health Study.

Longer use of ibuprofen or acetaminophen was associated with potentially higher risk of impaired hearing.

The researchers noted that most of the women in the study were older and white. They said larger studies that include other groups of people are needed to learn more about the possible link between pain relievers and hearing loss.

The research team previously found that higher use of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDS) was associated with increased risk of hearing loss in men and younger women.

“Hearing loss is extremely common in the United States and can have a profound impact on quality of life,” Curhan said. “Finding modifiable risk factors could help us identify ways to lower risk before hearing loss begins and slow progression in those with hearing loss.”

Friday, January 6, 2017

Many with Breast Cancer Unnecessarily Choose Double Mastectomy

Many women with early stage breast cancer choose to have their healthy opposite breast removed, even when there are no medical indications that such a step is necessary, a new survey finds.

That’s especially true when the surgeon doesn’t offer a recommendation either way, the researchers said.

“We are seeing that one in six breast cancer patients are choosing bilateral mastectomy when this aggressive procedure is not going to benefit them in terms of survival,” said Dr. Reshma Jagsi.

Jagsi, who led the study, is a professor and deputy chair of radiation oncology at the University of Michigan School of Medicine.

Cancer specialists say no compelling evidence suggests a survival advantage for most patients to choose a double mastectomy. Also, the risk of getting cancer in the opposite healthy breast is low for most patients, they note.

However, after actress Angelina Jolie publicized her decision to undergo removal of both breasts, more women became aware of the option. Perhaps they think more is better, the researchers said.

Jagsi said she is disturbed that so many women choose such a radical approach. However, she understands how they perceive they are doing everything they can to avoid cancer.

Women for whom the double procedure might be warranted, she said, include those who have a very high cancer risk, such as the BRCA 1 or BRCA 2 gene mutations.

However, “for women with garden-variety breast cancer in one breast, the medical risks [of a preventive mastectomy in the opposite breast] really seem to outweigh the medical benefit,” Jagsi said.

Wednesday, January 4, 2017

Wisdom Wednesday: Bill’s Blog – A Review of 2016

Every New Year I like to review all the blogs I posted during the previous year. I look for trends, both good and bad, in an effort to improve my site.

My perception, prior to the review, is that I too often write about the negative aspects of health care – overprescribing drugs, needless surgery, Big Pharm, etc. I also feel I do the same with environmental concerns.

However, a review of my blogs paints a different story.

Fully a third of my blogs last year were on nutrition. They were pretty evenly split between diet and nutritional supplementation. My series on the eight most common diets last spring was, in my mind, the most informative. I hope that it provided some guidance in selecting and improving your diet. You can view any of these blogs in the archive under March, April and May.

About 13% of my blogs did chastise the U.S. health care system. That’s less than I imagined but it was still the second most popular topic. I guess we do tend to remember the negative more than the positive. Although I won’t leave the system alone, I will try to recommend action steps you can take to reduce your personal risks when dealing with our health care system. You must be your own health care advocate.

In third place this year were blogs about various drugs. They accounted for 10% of my blogs with posts about statin drugs leading the pack. There were also several posts about drugs and our aging population. My blog “How Older People Can Head Off Dangerous Drug Interactions”
posted on October 7, 2016 is worth review.

Number four was posts about the environment. Although most of them did spotlight negative impacts on our environment, a recent post on November 28th, “Mercury Levels Dropping in North Atlantic Tuna” highlights the positive changes that have resulted from efforts to reduce the burning of coal for fuel.

Monday, January 2, 2017

Heart Failure Protein May Signal Early Brain Damage

N-terminal Pro-B-type natriuretic peptide (NT-proBNP) is a protein released into the blood in response to heart wall stress. Blood levels of NT-proBNP rise when heart failure worsens and fall when it gets better.

Previous research has found a link between heart disease and brain disease, but the role of NT-proBNP was unclear.

Researchers in the Netherlands looked at nearly 2,400 middle-aged and elderly heart disease patients without dementia and found a clear association between blood levels of NT-proBNP and brain damage detected on MRIs.

The study was published online Dec. 7 in the journal Radiology.

“We found that higher serum levels of NT-proBNP were associated with smaller brain volumes, in particular with smaller gray matter volume, and with poorer organization of the brain’s white matter,” lead author Dr. Meike Vernooij said in a journal news release. She’s a neuroradiologist at Erasmus MC University Medical Center in Rotterdam.

Damage to the heart and brain often occur before any signs or symptoms of disease become apparent. A blood marker that can reveal early-stage heart and brain diseases could lead to earlier treatment and lifestyle changes, and possibly slow or even reverse the disease, the study authors noted.

They said further research is needed to learn more about NT-proBNP and the link between heart and brain disease.