Friday, June 29, 2018

16:8 Fasting Diet Actually Works

A form of intermittent fasting known as the 16:8 diet helps obese individuals to lose weight and lower their blood pressure, according to a new study.

More and more people now turn to intermittent fasting as a fast and effective way to lose weight. There are different forms of this diet, depending on the time intervals of “fasting” and “feasting.” The so-called 5:2 diet, for instance, consists of eating normally for 5 days every week and fasting for 2 days. In the fasting days, the dieter restricts their calorie intake to 500 or 600 per day. In the daily fasting, or the 16:8 diet, people eat whatever they like for 8 hours and fast for the remaining 16.

A new study evaluates the benefits of this 16:8 pattern for obese individuals and finds that not only does the diet work, but also that it helps to lower blood pressure.

As many as 93.3 million adults have obesity in the United States, according to the latest data from the Centers for Disease Control and Prevention (CDC). That’s almost 40% of the country’s entire population.

This research was led by corresponding author Krista Varady, an associate professor of kinesiology and nutrition at the University of Illinois at Chicago, and the findings were published in the journal Nutrition and Healthy Aging.

Varady and colleagues recruited 23 obese study participants who were aged 45 years, on average, with the average body mass index (BMI) of 35. Between 10 a.m. and 6 p.m., the participants could eat whatever and however much they liked, but they were only allowed to drink water and calorie-free drinks for the remaining 16 hours.

Wednesday, June 27, 2018

Wisdom Wednesday: Fish Oil Consumption Does Not Increase Bleeding Risk

Fish oil is rich in omega-3 fatty acids EPA and DHA. Increased intake of EPA and DHA is beneficial for cardiovascular health, cognitive function, mental health, maternal and child health, immunity and inflammation. EPA and DHA supplements are becoming more and more popular across a wide diversity of people, from healthy individuals to vulnerable population with impaired health.

Higher omega-3 concentrations may compete with fatty acids such as arachidonic acid for metabolizing enzymes. The interaction results in a decreased production of compounds that induce platelet aggregation and an increased production of compounds with anti-platelet properties, hence the anticoagulation benefits of omega-3. However, for patients who are under antithrombotic therapy (either with platelet aggregation inhibitors such as aspirin or anticoagulant drugs such as warfarin), the potential risk of bleeding due to the concurrent use of omega-3 fatty acids has been a concern by many clinicians, particularly surgeons.

Multiple clinical studies have been conducted to investigate whether omega-3 fatty acids pose a clinically significant bleeding risk. So far, the findings have been consistent:

A 2004 Cochrane review of 48 randomized controlled trials and 41 epidemiological analyses concludes that 0.4-7 g/day omega-3 fatty acids do not result in any change in clinical bleeding manifestations.

A 2007 review of 19 clinical studies involving nearly 4400 surgical patients concludes that the risk for clinically significant bleeding was virtually nonexistent with the use of 1.4-21 g/day of omega-3 fatty acid supplements, even with the concurrent use of antiplatelet or antithrombotic medications.

A 2013 systematic review of 10 randomized trails involving nearly 1000 adults 60 years or older concludes that there is no difference in total adverse event rates between daily use of placebo or 0.03-1.86 g EPA and/or DHA for 6-52 weeks.

A 2014 review of 7 randomized controlled trails and 3 epidemiological studies concludes that omega-3 fatty acid treatment has no effect on the risk of clinically significant bleeding and there is no support for discontinuing the use of omega-3 fatty acids before invasive procedures.

A 2017 systematic review based on 32 publications on healthy subjects and 20 publications on patients undergoing surgery finds that fish oil supplements reduce platelet aggregation in healthy subjects and do not increase intra- or post-operative bleedings in patients, and concludes that discontinuation of fish oil supplements prior to surgery is not recommended.

Monday, June 25, 2018

Florida Red Tide

A red tide, or harmful algal bloom, is a higher-than-normal concentration of microscopic alga. In Florida and the Gulf of Mexico, the species that causes most red tides is Karenia brevis.

At high enough concentrations, Florida red tide can discolor water a red or brown hue. Other algal species can appear red, brown, green or even purple. At lower concentration, the water color appears normal during a bloom.

Red tides were documented in the southern Gulf of Mexico as far back as the 1700s and along Florida’s Gulf coast in the 1840s. Fish kills near Tampa Bay were even mentioned in the records of Spanish explorers.

The duration of a bloom can be as little as a few weeks or longer than a year. In nearshore Florida waters, it depends on sunlight, nutrients and salinity. The speed and direction of the wind a water currents are also factors.

K. brevis cannot tolerate low-salinity waters for very long, so blooms usually remain in salty coastal waters and do not penetrate upper reaches of estuaries. However, other harmful algae, including cyanobacteria (blue-green algae), typically bloom in freshwater lakes and rivers.

Many red tides produce toxic chemicals that can affect both marine organism and humans. The Florida red tide organism, K. brevis, produces brevotoxins that can affect the central nervous system of fish and other vertebrates, causing these animals to die. Wave action can break open K. brevis cells and release these toxins into the air, leading to respiratory irritation. The red tide toxins can also accumulate in molluscan filter-feeders such as oysters and clams, which can lead to Neurotoxic Shellfish Poisoning in people who consume contaminated shellfish.

Wednesday, June 20, 2018

Wisdom Wednesday: Vitamin D May Decrease Breast Cancer Risk

The merits of vitamin D when it comes to cancer prevention have long been at the heart of medical debates. Where some studies have revealed that overall cancer risk is lower in people with higher levels of this vitamin, others have suggested that vitamin D has no impact on a person’s vulnerability to the disease.

Still, the case for ensuring that you get enough vitamin D is fairly strong, as low blood levels of this nutrient have been associated with raised risk of bladder cancer and, in a study that was published earlier this year, an elevated risk of bowel cancer. Previous research has also suggested a link between high vitamin D levels and better survival rates in people going through breast cancer treatment.

In a pooled analysis of a prospective cohort study and two randomized clinical trials, researchers at the University of California, San Diego School of Medicine have now investigated whether and to what extent high levels of vitamin D in the blood were associated with a lower risk of developing breast cancer.

Their analysis – which was conducted in collaboration with specialists from Creighton University in Omaha, ND, the Medical University of South Carolina in Columbia, and the nonprofit organization GrassrootsHealth in Encinitas, CA – suggests that certain levels of vitamin D correlate with a “markedly lower” risk of breast cancer. These results are now published in the journal PLOS ONE.

“We found that participants with blood levels of 25(OH)D that were above 60 nanograms per milliliter (ng/ml) had one-fifth the risk of breast cancer compared to those with less than 20 ng/ml.” – Cedric F. Garland.

Monday, June 18, 2018

Parkinson’s: Vitamin B-3 May Stop Brain Cell Death

Vitamin B-3 may help to stop the death of nerve cells that occurs in Parkinson’s disease, according to a recent German-led study that may lead to new treatments for the brain-wasting disease.

The researchers’ paper is now published in the journal Cell Reports. In it, they report how a form of vitamin B-3 called nicotinamide riboside helped to preserve nerve cells by boosting their mitochondria, or energy-producing centers.

“This substance,” explains senior study author Dr. Michela Deleidi, who leads brain research projects at the University of Tubingen and the Helmholtz Association – both in Germany – “stimulates the faulty energy metabolism in the affected nerve cells and protests them from dying off.” In the case of Parkinson’s disease, studies have shown that the dopamine cells that die off have damaged mitochondria.

Dr. Deleidi and her colleagues wondered whether faulty mitochondria are a cause or whether they are “merely a side effect” of the disease. First, they took skin cells from individuals with Parkinson’s disease who carried versions of the GBA gene that are known to increase risk for the disease.

They got the skin cells to regress into immature stem cells, and they then coaxed the stem cells to become nerve cells. These nerve cells show similar mitochondrial dysfunction as that found in the brain cells in Parkinson’s disease.

The team then fed the cells with a form of vitamin B-3 called nicotinamide riboside, which is a precursor of the coenzyme. This caused NAD levels to rise in the cells and resulted in new mitochondria and increased energy production.

Friday, June 15, 2018

Fewer Than 1 in 10 Adults Get All High-Priority Preventive Care

Only 8% of US adults aged 35 years or older received all of the high-priority preventive care recommended for them, according to results of a survey published in the June issue of Health Affairs. Conversely, 5% of adults received none of those services.

Amanda Borsky, DrPH, MPP, a dissemination and implementation adviser in the Center for Evidence and Practice Improvement at the Agency for Healthcare Research and Quality in Rockville, Maryland, and colleagues found that the most commonly received preventive service in 2015 was blood pressure screening (87.3%), and the least commonly received was zoster vaccination for shingles (37.9%).

Common reasons for not getting preventive services include lack of insurance, lack of a usual source of care, and delayed access to care.

The researchers used data from the Preventive Services Self-Administered Questionnaire of the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey from January to May 2015 to examine receipt of 15 preventive measures: screenings for blood pressure, cholesterol, breast cancer, colon cancer, cervical cancer, osteoporosis, and prostate-specific antigen; screening and counseling for tobacco, obesity, alcohol use, and depression; influenza, zoster, and pneumococcal vaccines; and counseling for aspirin use.

Among the 2759 adults aged 35 years and older eligible to complete the Preventive Services Self-Administered Questionnaire, 2186 (79.2%) did.

With respect to the proportion of respondents who received all appropriate preventive care, there was no significant difference between men and women or by age. However, men were almost twice as likely as women to receive 25% fewer of the services. Men were also 3 times as likely as women to have received no recommended services. “The only service received more often by men than women was counseling on aspirin use,” the authors write.

Wednesday, June 13, 2018

Wisdom Wednesday: PSA Versus Free PSA

Prostate-specific antigen (PSA) is a protein made mainly in the prostate. A bit of PSA is released into the bloodstream during each ejaculation, and PSA in ejaculate makes it easier for the semen to carry sperm to the fallopian tubes during conception. PSA can have two basic states. It may be bound to another protein or float free.

The total PSA and free PSA tests both measure levels of PSA in the blood. Results help doctors to diagnose issues like prostate cancer and inflammation of the prostate. A total PSA measures all the PSA, including the antigens that are bound and those that are floating freely. A free PSA test only measures the amount of PSA that is floating freely in the bloodstream without being bound to a different protein.

Both tests are used to diagnose prostate issues. A person may have an increased risk of prostate cancer when they have higher levels of total PSA and lower levels of free PSA.

A free PSA test is typically given after a total PSA test to help doctors rule out cancer or to indicate how far cancer has progressed after treatment. The free PSA test is often used before a biopsy to provide initial confirmation of a doctor’s diagnosis.

There are some drawbacks to using PSA testing. There may be high rates of false positives, normal results do not rule out prostate cancer, and people may also have elevated levels of PSA without having cancer.

Monday, June 11, 2018

‘Millions’ Prescribed Wrong Dose of Common Drugs

According to updated calculations published this week, over 11 million people in the United States may have been given the wrong prescription for a range of commonly used drugs.

Scientists from the Stanford University School of Medicine in California recently investigated the reliability of so-called pooled cohort equations (PCEs). PCEs help doctors to determine each patient’s overall risk of stroke or heart attack. Assessing cardiovascular risk helps to inform the physician about the exact level of medication that will be both effective and safe. These equations are available as online web tools and smartphone apps, and they are even built into digital medical records.

In recent years, some have called into question the accuracy of PCEs, asking whether the data that they rely on are outdated. If this were found to be the case, patients could potentially be at risk of taking dangerously high or ineffectively low doses of drugs.

Dr. Sanjay Basu, Ph.D., an assistant professor of primary care outcomes research at Stanford published his findings this week in the journal Annals of Internal Medicine.

The first issue was updating the data used to derive the equations. Some of the datasets are relatively old. For instance, one included information from people who were aged 30-62 in 1948. Diet, lifestyle and health risks have changed since those days. The study authors say that, because of the age of this information, people’s risks were being estimated at around 20% higher than they truly were. Dr. Basu notes that “relying on our grandparents’ data to make our treatment choices is probably not the best idea.”

“Another issue the researchers identified was the lack of African-Americans in the datasets. It is now known that cardiovascular risk is significantly higher in the African-American population. So, while many Americans were being recommended aggressive treatments that they may not have needed according to current guidelines, some Americans – particularly African-Americans – may have been give false reassurance and probably need to start treatment given our findings.” – Dr. Sanjay Basu, Ph.D.

Friday, June 8, 2018

Is Chemo for Breast Cancer overprescribed?

According to a landmark study, a large percentage of individuals with the most common form of early breast cancer could safely skip chemotherapy. The findings could impact thousands of people each year.

While new therapies such as immunotherapies are becoming increasingly crucial in treating cancer, chemotherapy is still a mainstay. Though chemotherapy is effective, it carries with it a range of significant side effects, such as hair loss, increased risk of bleeding, susceptibility to infection, nausea, vomiting, and anemia. Consequently, chemotherapy is only used when deemed entirely necessary. The challenge lies in determining exactly when it is entirely necessary.

Individuals with breast cancer sometimes have their tumors analyzed using a gene test called the Oncotype DX test. This examines how active 21 specific genes are provides a “recurrence score” of 0-100. When scores are high, chemotherapy will be used following surgery or radiation therapy to lower the risk of the cancer returning. For individuals with low scores, the tumors are considered less dangerous, and chemotherapy is not deemed essential.

This type of testing has proven useful but there is a substantial gray area. As it stands, those who score 1-10 do not receive chemotherapy and those who score above 25 do. The majority of women, however, fall in the intermediate range of 11-25.

To get a better picture of who needs treatment, researchers from Loyola Medicine and Montefiore Medical Center undertook a large-scale investigation. Their findings are now published in the New England Journal of Medicine.

They used data from more than 10,000 women with hormone-receptor-positive, HER-2 negative breast cancer – the most common form of breast cancer, accounting for about half of breast cancer cases in the United States. Of particular interest were the 69% of women who had scored 11-25 on the 21-gene test.

Wednesday, June 6, 2018

Wisdom Wednesday: Plant Pigments May Preserve Lung Function into Old Age

New research finds that flavonoids – which are natural chemical compounds found in plants, such as fruits and vegetables – can help to slow the decline in lung function that tends to occur with age.
As the plants’ pigments, flavonoids are responsible for the vibrant colors of fruits and vegetables. They also attract pollinating insets and regulate cell growth. Research has suggested that dietary flavonoids may hold a lot of benefits for human health.

In vivo and in vitro studies have exposed flavonoids’ range of anti-inflammatory and antidiabetic properties, as well as their anticancer and neuroprotective benefits. New research adds to this list, suggesting that a certain type of flavonoid called “anthocyanins” can help to maintain healthy lung function well into old age.

The research was led by Vanessa Garcia-Larsen, Ph.D., who is an assistant professor in the Human Nutrition Division of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD. The findings were presented at the American Thoracic Society International Conference, held in San Diego, CA.

For this study, the researchers looked at data available from 463 adults from Norway and England – aged 44, on average – who took part in a spirometry test at the beginning of the study and at different follow-up times.

Spirometry is a pulmonary lung function test that measures the airflow and the volume of air that a person can exhale on command.

Additionally, the study participants had filled in a dietary questionnaire, so the researchers were able to divide the participants into quartiles, or fourths, based on their dietary intake of anthocyanins.
The research revealed that the highest quartile of anthocyanin consumers, when compared with the lowest, had a much slower rate of decline in all three aspects of lung function measured by the spirometry.

Monday, June 4, 2018

Pesticides May Cause Parkinson’s in Some People

New research reveals how the pesticides paraquat and maneb alter gene expression and may lead to Parkinson’s disease in people who are genetically predisposed to the illness.

Estimates show that around 50,000 people in the United States are diagnosed with Parkinson’s disease every year. Although it is not exactly known what causes the disease, both genetic and environmental factors are thought to play a critical role.

Senior study author Scott Ryan, a professor of molecular and cellular biology at the University of Guelph in Ontario, Canada explains the motivation behind the research. He notes, “People exposed to these chemicals are at about a 250% higher risk of developing Parkinson’s disease than the rest of the population.”

The findings were published in the journal Federation of American Societies for Experimental Biology.

The researchers used stem cells from patients with Parkinson’s disease who had a mutation in the gene responsible for encoding the a-synuclein protein. At least 30 alterations in this gene have been associated with Parkinson’s, and a-synuclein protein clumps are a well-documented, albeit poorly understood, hallmark of the disease. The scientists also worked with normal embryonic cells that they modified using genetic editing to replicate the a-synuclein genetic mutation.

Prof. Ryan explains why using human cells makes this study particularly valuable. “Until now,” he says, “the link between pesticides and Parkinson’s disease was based primarily on animal studies as well as epidemiological research that demonstrated an increased risk among farmers and others exposed to agricultural chemicals.” “We are one of the first to investigate what is happening inside human cells,” he explained.

It was found that the neurons that had been exposed to the chemical had faulty mitochondria. Mitochondria, the “powerhouses of the cell,” are the organelles inside a cell that turn sugar, fats, and proteins in to the energy our body needs to survive and function.

Friday, June 1, 2018

Shoulder Subluxation

Shoulder subluxation refers to a partial dislocation of the shoulder joint. This occurs when the ball of the upper arm bone, called the humerus, partly comes out of the glenoid socket in the shoulder.

The shoulder is the most mobile joint in the body. It contains several bones, ligaments, and muscles that work together to keep it stable. Because the shoulder is so mobile, it is very susceptible to dislocation. Shoulder subluxation is often the result of trauma, injury or a stroke that weakens the arm muscles.

Symptoms of a shoulder subluxation can include a visibly deformed or out-of-place shoulder, pain, swelling, numbness or tingling or trouble moving the joint. A person may be able to feel the ball of the humerus moving in and out of the shoulder socket. They may also notice a clicking or catching sensation especially when reaching overhead.

Treatment aims to reposition the humerus back into the socket and ensure that it stays in place. Treatment options include: 1. Closed reduction involves a doctor attempting to gently maneuver the bone back into position. When this is achieved, severe pain should improve almost immediately. 2. Surgery may be recommended when dislocations recur or when nerves, blood vessels, or ligament in the shoulder have been damaged. 3. A splint, brace, or sling for a few days or weeks to prevent the shoulder from moving. The length of time will depend on the extent of the dislocation. 4. A muscle relaxant and an anti-inflammatory agent, such as ibuprofen, for pain and swelling. 5. Rehabilitation following surgery or time spent in a sling.

When a person seeks medical attention promptly and receives a correct diagnosis, shoulder subluxation is treatable. When no surgery is recommended, several months may pass before a person call tell how well the treatment is working.