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.