Wisdom Wednesday: RNA

Ribonucleic acid or RNA acts as a messenger between DNA and the protein synthesis complexes known as ribosomes, forms vital portions of ribosomes, and acts as an essential carrier molecule for amino acids to be used in protein synthesis.

RNA is very similar to DNA, but differs in a few important structural details: RNA is single stranded, while DNA is double stranded. Also, RNA nucleotides contain ribose sugars while DNA contains deoxyribose and RNA uses predominantly uracil instead of thymine present in DNA.

RNA is transcribed from DNA by enzymes called RNA polymerases and further processed by other enzymes. RNA serves as the template for translation of genes into proteins, transferring amino acids to the ribosome to form proteins, and also translating the transcript into proteins.

RNA is a polymer with a ribose and phosphate backbone and four different bases: adenine, guanine, cytosine, and uracil. The first three are the same as those found in DNA, but in RNA thymine is replaced by uracil as the base complementary to adenine.

Uracil is energetically less expensive to produce than thymine, which may account for its use in RNA. Having thymine as the normal base in DNA makes detection and repair of incipient mutations more effective. Thus uracil is appropriate for RNA, where quantity is important but lifespan is not, whereas thymine is appropriate for DNA where maintaining sequence with high fidelity is more critical.

Wisdom Wednesday: Research Study on the Effectiveness of Stem Cell Injections

Between June 2014 and February 2017, data from 233 patients with knee osteoarthritis treated with BMAC injection at a single center were retrospectively evaluated. Only patients with idiopathic osteoarthritis were included. Exclusion criteria were post-traumatic osteoarthritis, previous knee surgery, age less than 50 years old or more than 85 years old, active infection, uncontrolled diabetes mellitus, rheumatological or other systemic disease, malignancy, or treatment with immunosuppressive drugs. Bone marrow from the iliac crest was aspirated/concentrated with a standardized technique using a single-spin manual method. Patients were evaluated before and after the procedure, using the numeric pain scale (NPS) and Oxford knee score (OKS). Mean follow-up period was 11 months, range (6e30 months).

A total of 121 of 233 patients had completed data as previously defined and were included in the statistical analysis. There were 85 females and 36 males, with mean age 70 years (range 50e85). Compared to baseline, the mean NPS decreased from 8.33 to 4.49 (p 0.001) and the mean OKS increased from 20.20 to 32.29 (P 0.001) at final follow-up. There were no complications.

A single intra-articular injection of BMAC is a safe and reliable procedure that results in clinical improvement of knee OA.

My Take:
This is just the summary of the full article which Apex was kind enough to send to me. The published study listed any conflicts of interest, financial support and most importantly limitations of the study. The study was self-supported by the clinic in Greece that performed all the procedures without any outside financial support.

Wisdom Wednesday: Improved Quality of Life with Magnesium

Recent research looked at the disability levels, quality of life, and anxiety and depressive symptoms in 34 children aged 7-17 after six months of magnesium prophylaxis for pediatric migraines. According to the researchers, “After 6 months of magnesium prophylaxis, disability due to migraine significantly decreased, whereas physical and psychosocial well-being improved.”

Magnesium is the fourth most abundant mineral in the body and is a cofactor for more than 300 enzyme systems regulating a variety of chemical reactions in the body. Magnesium is involved in protein synthesis, muscle and nerve function, blood sugar control, and regulation of blood pressure. Magnesium is also involved in energy production as it is necessary for ATP production and glycolysis. Magnesium also contributes to the structural development of bone and is necessary for the synthesis of DNA and RNA.

Magnesium is important for detoxification as it is needed to product glutathione. Magnesium also plays a role in the active transport of calcium and potassium ions across cell membranes, a process that is important to nerve impulse conduction, muscle contraction, and normal heart rhythm. Other studies also show a link between low magnesium and headaches.

Wisdom Wednesday: Detox Drinks

Some people claim that detox drinks help remove toxins from a person's body and promote weight loss. Typically, a person will include detox drinks as part of a detox diet. However, there is very little evidence that these types of drinks and diet have any detoxification effects. The use of the word detox is not always appropriate. Detox drinks may boost health, aid in weight loss, and support the body's natural detoxification processes, but this is different from medical detoxification.

An article in the Journal of Human Nutrition and Dietetics notes that some studies show that commercially available detox diets may improve the way a person's liver removes toxins from their body. However, the article also highlights that these studies had flawed methodologies and small sample sizes. A study in the journal Current Gastroenterology Reports found that a detox diet may help a person lose weight, but only because the diet is low in calories. Further, the authors note that diets that help a person lose weight by significantly reducing the number of calories they consume are unsustainable. Typically, people who undertake such calorie-restrictive diets put the weight back in the medium-to-long term.

The National Center for Integrative and Natural Health (NCINH) point out that as well as causing problems with a person's weight in the mid-to-long term, a person on a detox diet may not be getting the nutrition they require to keep their body healthy. Although they do not detox in the medical sense, detox drinks can be healthful.

Typically, people use a food processor to turn raw ingredients into a smoothie. As well as being a convenient way to consume fruits and vegetables, using fresh ingredients preserves the fiber in fruits and vegetables, which the juice alone lacks.

Wisdom Wednesday: Prescription Drug Use

During 2015-2016, about 46% of the US population used one or more prescription drugs in the past 30 days, down slightly from 48% a decade ago, according to new data from the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention.
For the 2015-2016 period, prescription drug use increased with age, from 18% among children younger than 12 years to 85% among adults 60 and older, Cynthia L. Ogden, PhD, and colleagues report in a data brief published online May 8.

Prescription drug use was lower among males (42%) than females (50%), although the pattern differed by age. Among children up to age 11, prescription drug use was higher among boys (22%) than girls (14%), while among adults aged 20 to 59, prescription drug use was lower among men (38%) than women (56%). There were no significant differences by gender among adolescents aged 12 to 19 or adults aged 60 or over.

Prescription drug use was highest among non-Hispanic whites (50%), followed by non-Hispanic blacks (45%), and lowest among non-Hispanic Asian (33%) and Hispanic individuals (37%).

Thyroidectomy Seems to Improve Quality of Life in Hashimoto Disease

Total thyroidectomy appears to improve quality of life in patients with Hashimoto disease, according to a study in the Annals of Internal Medicine.

Roughly 150 adults with Hashimoto-related symptoms despite adequate hormone substitution were randomized to receive either total thyroidectomy with standard medical therapy or medical therapy alone. All had serum antithyroid peroxidase (anti-TPO) antibody titers above 1000 IU/mL at baseline.

At 18 months, surgery patients had significantly better health-related quality-of-life scores than did controls. Surgery patients also had improved fatigue scores, and their serum anti-TPO antibody levels were significantly lower.

My Take:
Hashimoto’s disease is an autoimmune disease of the thyroid gland. It is estimated that a third of all patients suffering from hypothyroidism have Hashimoto’s.

The condition often goes undiagnosed as the confirmatory tests – thyroid peroxidase and thyroid autoantibodies – are seldom performed. However, there is renewed interest in Hashimoto’s as evidenced by this study.

Traditional treatment of Hashimoto’s disease is limited to hormone replacement therapy using Synthroid. There is no medical approach to treat the underlying autoimmune disease. Even in this extreme treatment where the thyroid gland is surgically removed, the underlying disease is not addressed.

Wisdom Wednesday: Mineral Water versus Tap Water

Mineral water comes from underground reservoirs. Unlike regular drinking water, mineral water does not undergo chemical processing. As the name suggests, mineral water contains high quantities of minerals, especially magnesium, calcium, and sodium. But is mineral water better than regular water, and what are its benefits?

This article discusses some possible health benefits associated with drinking mineral water.

All living organisms need water to survive. Not only does water support essential physical functions, it also provides vital nutrients that the body does not produce on its own. While most people in the United States have access to clean drinking water, many people choose bottled mineral water for its perceived purity and potential health benefits.
How does mineral water compare with regular water? Based on the current evidence, the differences are not very significant. The water in household taps comes either from surface or underground sources.

In the U.S., tap water must meet the Safe Drinking Water Act standards established by the
Environmental Protection Agency (EPA). These regulations limit the number of contaminants present in water supplied to homes. Public water suppliers move water from its source to treatment plants, where it undergoes chemical disinfection. The clean water ultimately gets delivered to households through a system of underground pipes.

Wisdom Wednesday: Metformin for Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

Clinical Question
How effective is metformin in the treatment of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis?

Evidence-based Answer
Metformin does not seem to be an effective treatment for nonalcoholic steatohepatitis. There are no studies evaluating whether metformin improves long-term patient-oriented outcomes such as progression from NAFLD to nonalcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma, or death from liver failure. Metformin does not improve anatomic outcomes (histologic or ultrasound features of the liver) or biochemical outcomes (alanine transaminase [ALT] and aspartate transaminase [AST] levels, or insulin resistance) in adults. Metformin does not improve liver histologic or biochemical outcomes, or body mass index (BMI) in adults with nonalcoholic steatohepatitis. (Strength of Recommendation: C, based on a meta-analysis of randomized, controlled trials [RCTs] evaluating laboratory parameters.) Similarly, metformin does not improve histologic or biochemical outcomes, or BMI in children and adolescents with NAFLD. (Strength of Recommendation: C, based on RCTs evaluating laboratory parameters.)

Evidence Summary
Adults With NAFLD
No studies have evaluated patient-oriented outcomes of metformin therapy for NAFLD or nonalcoholic steatohepatitis. An RCT found no improvement in liver histology on biopsy.[1,2] Two placebo-controlled RCTs (N = 113) evaluating the effect of metformin (850 to 1,700 mg per day) on ALT and AST levels, insulin resistance, and BMI found no differences. One RCT (n = 48) found a small decrease in BMI. Another RCT (n = 2,153) found no improvement in ALT levels after treatment with metformin (850 mg twice per day) vs. placebo.[2]

Adults With Nonalcoholic Steatohepatitis
Two RCTs (N = 52) evaluating metformin (500 to 1,000 mg per day) in patients with nonalcoholic steatohepatitis found that it did not improve liver histology, ALT and AST levels, BMI, or insulin resistance.[1,3]

Children With NAFLD
Two RCTs (N = 172) evaluating metformin (1,000 to 1,500 mg per day) vs. placebo in children with obesity and NAFLD found no improvement in liver histology on biopsy, ALT and AST levels, BMI, or insulin resistance.[4,5] A smaller RCT (n = 50; mean age: 15 years) found that metformin (850 mg twice per day) improved ultrasound scores for fatty liver but did not improve ALT and AST levels.[6]

Recommendations From Others
An evidence-based guideline from the American Association for the Study of Liver Diseases, the American College of Gastroenterology, and the American Gastroenterological Association states that metformin has no significant effect on liver histology and is not recommended as a treatment for liver disease in adults with nonalcoholic steatohepatitis.[7]

Wisdom Wednesday: Continuing ARB Recalls Shake Up Hypertension, HF Care

Concerns over ongoing recalls of angiotensin II receptor blockers (ARBs) are forcing physicians and patients to choose between optimal treatments and rattling confidence in the safety of the generic drug supply itself.

"I see hypertension on a regular basis and on any given clinic day, four to five patients have either stopped their medicines or have considered stopping their medicines and a separate detailed conversation has to be put in place to try to convince them to continue," Keith Ferdinand, MD, Tulane University Heart and Vascular Institute, New Orleans, told theheart.org | Medscape Cardiology.

ARBs are recommended for the treatment of hypertension, heart failure, and chronic kidney disease, with more than 61 million prescriptions written for valsartan, losartan, and irbesartin in the United States in 2016, according to the federal ClinCalc DrugStats database.

Ongoing US Food and Drug Administration (FDA) recalls — all in generic ARB-containing products — began last July when the probable carcinogen N-nitrosodimethylamine (NDMA) was detected in the valsartan active pharmaceutical ingredient (API) supplied by Zhejiang Huahai Pharmaceuticals (ZHP), Linhai, China.

Within months, the rolling recalls had extended to irbesartan- and losartan-containing products. A second probable carcinogen, N-nitrosodiethylamine (NDEA), was identified last fall and a third, N-nitroso-N-methyl-4-aminobutyric acid (NMBA), only last month.

Wisdom Wednesday: Alzheimer's: 'Holy herb' extracts shows promise as future treatment

Yerba santa, a plant with a long history of medicinal use in its native California, contains an active compound that could treat people with Alzheimer's disease one day. This was the conclusion that scientists at the Salk Institute for Biological Studies in La Jolla, CA came to after testing 400 plant extracts with known medicinal properties. Using a new drug-discovery screen, they tested the compounds for their ability to deter the effects of aging on the brain. The initial round of tests yielded several extracts that protected against a type of cell death that occurs in Alzheimer's and other aging-related diseases. Further tests revealed that sterubin, an extract of Eriodictyon californicum, or Yerba santa, was the most able to shield against inflammation and other triggers of brain cell death.

Native tribes of California have long valued Yerba santa, which is the Spanish for "holy herb," very highly as a medicine for respiratory illnesses, fever, infections, bruising, pain, and headaches.

According to a 2018 Alzheimer's Disease International report, dementia affects 50 million people worldwide, two-thirds of whom have Alzheimer's disease. In the U.S., the number of people living with Alzheimer's disease is set to rise from approximately 5.7 million people today to nearly 14 million by 2050.

Wisdom Wednesday: Fecal Immunochemical Tests

Performance Characteristics of Fecal Immunochemical Tests for Colorectal Cancer and Advanced Adenomatous Polyps: A Systematic Review and Meta-analysis

Purpose:
To summarize performance characteristics of FITs for CRC and advanced adenomas in average-risk persons undergoing screening colonoscopy (reference standard) and to identify factors affecting these characteristics.

Data Sources:
Ovid MEDLINE, PubMed, Embase, and the Cochrane Library from inception through October 2018; reference lists of studies and reviews.

Study Selection:
Two reviewers independently screened records to identify published English-language prospective or retrospective observational studies that evaluated FIT sensitivity and specificity for colonoscopic findings in asymptomatic, average-risk adults.

Data Extraction:
Two authors independently extracted data and evaluated study quality.

Data Synthesis:
Thirty-one studies (120 255 participants; 18 FITs) were included; all were judged to have low to moderate risk of bias. Performance characteristics depended on the threshold for a positive result. A threshold of 10 µg/g resulted in sensitivity of 0.91 (95% CI, 0.84 to 0.95) and a negative likelihood ratio of 0.10 (CI, 0.06 to 0.19) for CRC, whereas a threshold of greater than 20 µg/g resulted in specificity of 0.95 (CI, 0.94 to 0.96) and a positive likelihood ratio of 15.49 (CI, 9.82 to 22.39). For advanced adenomas, sensitivity was 0.40 (CI, 0.33 to 0.47) and the negative likelihood ratio was 0.67 (CI, 0.57 to 0.78) at 10 µg/g, and specificity was 0.95 (CI, 0.94 to 0.96) and the positive likelihood ratio was 5.86 (CI, 3.77 to 8.97) at greater than 20 µg/g. Studies had low to high heterogeneity, depending on the threshold. Although several FITs had adequate performance, sensitivity and specificity for CRC for 1 qualitative FIT were 0.90 and 0.91, respectively, at its single threshold of 10 µg/g; positive and negative likelihood ratios were 10.13 and 0.11, respectively. Comparison of 3 FITs at 3 thresholds was inconclusive: CIs overlapped, and the comparisons were across rather than within studies.

Limitations:
Only English-language studies were included. Incomplete reporting limited quality assessment of some evidence. Performance characteristics are for 1-time rather than serial testing.

Conclusion:
Single-application FITs have moderate to high sensitivity and specificity for CRC, depending on the positivity threshold. Sensitivity of 1-time testing for advanced adenomas is low, regardless of the threshold.

Primary Funding Source:
Department of Medicine, Indiana University School of Medicine.

My Take:
This is an abstract taken directly from the Annals of Internal Medicine, February 26, 2019. Typically I “dummy it down” a little, but I thought you might find the original abstract interesting. It’s a retrospective study using two independent authors as noted above. Please note how they not only present the data, but also the limitations prior to any conclusions. Finally, they also list the funding. In this case, it appears to be independent of bias.

Bottom Line:
Cologuard is the most popular trade name for this home test. It is available by prescription only but is covered by most insurance. Despite the limitation in testing for advanced adenomas, it is quite accurate in testing for colorectal cancer. I highly recommend you ask your primary care provider to add this test to your annual physical.

Wisdom Wednesday: Zinc and Hypertension

New research links zinc deficiency to hypertension. Zinc is involved with hundreds of enzyme systems and has other health implications. Zinc has been shown to be beneficial for learning and cognition  and is also recommended for people with a genetic predisposition to heart disease. It may even mitigate certain degenerative effects of aging. Some research indicates zinc deficiency may be a component of dementia.

The link to zinc deficiency and hypertension has been shown in an earlier cohort study, and a new animal study suggests a possible mechanism. Zinc deficient mice were compared to those with normal zinc levels. The researchers found that the zinc deficient mice had decreased sodium excretion and, therefore, higher blood pressure when compared to healthy controls. Zinc deficiency increases blood pressure by causing an upregulation of sodium chloride cotransporter (NCC) and a decrease in sodium excretion.

The researchers stated, “This study links dysregulated renal sodium handling to zinc deficiency induced hypertension. Furthermore, NCC is identified as a novel mechanism by which zinc regulates blood pressure. Understanding the mechanisms of zinc deficiency induced BP dysregulation may have important therapeutic impact on hypertension.”

My Take:
For years, what little attention to diet and hypertension has focused on limiting sodium intake. Unfortunately, conventional health care does not differentiate between organically bound sodium (think celery) and inorganic sodium (added to processed meats). The latter is associated with hypertension, not the former.

Wisdom Wednesday: Statins Lower Risk for CV Events in Elders, But Benefits for Primary Prevention Still in Question

Statin therapy lowers the risk for vascular events in adults over age 70, according to a meta-analysis in The Lancet. However, the benefit seems apparent only in those with a history of vascular disease.

Researchers examined data from 28 randomized trials that either compared statin use with nonuse or compared intensive statin regimens with standard treatment. Over 185,000 participants were included, of whom 15% were age 71–75 and 8% were older than 75.

During roughly 5 years' follow-up, statin use or intensive treatment was associated with a significant reduction in major vascular events across all age groups — overall, a 21% reduction in risk with each 1-mmol/L (39-mg/dL) decrease in LDL cholesterol. However, when stratified by history of vascular disease, a significant benefit among those aged 71 and older was limited to those with prior vascular disease.

My Take:
The full article is available online from The Lancet. These findings are strikingly similar to those found with aspirin – it’s best used for patients with a history of cardiovascular disease than for prevention.

Wisdom Wednesday: Heavy Metals Found in Popular Fruit Juices

Nearly half of 45 fruit juices tested had elevated levels of heavy metals, which can pose health risks for children and adults, Consumer Reports has found.

The report, released Wednesday, says that even small amounts of juice might hold risks.
"In some cases, drinking just 4 ounces a day — or half a cup — is enough to raise concern," James Dickerson, PhD, chief scientific officer for CR, says in the report.

If anything, the results simply reinforce existing concerns about fruit juices. "I don't think we need to say you can't give your kids any juice," says Steven Abrams, MD, a professor of pediatrics at Dell Medical School, University of Texas at Austin. But, he says, "juice is not a product that is intrinsically healthy for children." He coauthored the American Academy of Pediatrics' guidelines on juice, which set limits by age. Meanwhile, juice producers say the report needlessly alarms consumers.

Consumer Reports experts tested 45 juices made by 24 brands, including well-known and lesser-known brands such as Gerber, Minute Maid, Mott's, Great Value from Walmart, Clover Valley from Dollar General, and Big Win from Rite Aid. Those tested included organic products, too, as well as store brands from Whole Foods and Trader Joe's.

They focused on levels of cadmium, lead, mercury, and inorganic arsenic, saying that these elements pose some of the greatest risks and that research has found they are common in food and drink. The juices tested were apple, fruit blends, grape, and pear.

The new testing was done as a follow-up to a study in 2011, when CR found elevated levels of inorganic arsenic and lead in apple and grape juices. The new evaluation was done to see if there's been improvement, to test other juices, and to test for other heavy metals.

Overall, CR says, heavy metal levels in fruit juices have declined since their last testing. But in the new report, every juice contained at least one of the four metals tested, and 47%, or 21, had concerning levels of cadmium, inorganic arsenic, and/or lead. None had concerning levels of mercury. Other major conclusions: Seven of the 21 had enough heavy metals to potentially harm children who drink a half-cup or more a day, and nine of the 21 held risks for kids drinking a cup or more a day. Ten of the juices posed a risk to adults, too: Five were potentially hazardous at a half-cup or more a day, and five at a cup or more a day. The highest heavy metal levels were in grape juice and juice blends. Organic juices did not have lower heavy metal levels than non-organic.

Wisdom Wednesday: Gut Microbiota and the Neuroendocrine System

The gut-brain axis is undeniable, but specific mechanisms of influence continue to be investigated. Specifically, the gut microbiota is now considered the body’s major neuroendocrine system, controlling body processes including the stress response and the hypothalamic-pituitary-adrenal (HPA) axis.

Back in the early 20th century, Nobel laureate, Ilya Metchnikoff, observed that the growth of cholera could be reduced by some microbes and enhanced by others. He proposed that commensal bacteria within the intestine could contribute to protection against this pathogen and alteration of the gut bacteria could prevent disease. In 2001, Nobel Prize winner Joshua Lederberg coined the term “microbiome”. The microbiome is the “ecological community of commensal, symbiotic and pathogenic microorganisms” that can be found on mucosal surfaces, including the eye, mouth, lungs, and the gut. Recent research reviews the connection between the microbiota and the neuroendocrine system.

The article is a review of the literature showing the connection of the microbiome to remyelination, microglia function, diseases like multiple sclerosis (MS), recovery from spinal cord injury and even behavior. The article cites research that links MS with intestinal permeability. Other research shows a link between the microbiome and pediatric MS, suggesting a connection between myelin production and metabolites produced by gut microbes (particularly p-cresol). Short chain fatty acids from the bowel flora (especially butyrate) affect remyelination, microglia function, and also oligodendrocyte differentiation. In the autoimmune disease, neuromyelitis optica, research shows there may be a connection to bowel ecology. Another study showed the connection between CNS inflammation and the gut microbiome in mice.

25% of Antibiotic Prescriptions Could Be Inappropriate

At least a quarter of outpatient antibiotic prescriptions filled in 2016 may have been unnecessary, researchers conclude in The BMJ.

Using a national U.S. claims database, the researchers identified over 15 million outpatient antibiotic prescriptions filled in 2016 by privately insured children and adults under age 65. The most common antibiotics used were azithromycin, amoxicillin, and amoxicillin-clavulanate, accounting for roughly half of prescriptions.

On the basis of ICD-10-CM diagnosis codes:
23% of prescriptions were classified as inappropriate, usually for acute bronchitis, acute upper respiratory tract infection, or respiratory symptoms.

36% were potentially appropriate, most frequently for acute sinusitis, acute suppurative otitis media, or acute pharyngitis.

13% were considered appropriate, most often for urinary tract infections, streptococcal pharyngitis or tonsillitis, and bacterial pneumonia.

Some 29% of antibiotic prescriptions did not have an associated diagnosis code.

Wisdom Wednesday: Tension Headaches

Tension-type headache is very common, with a lifetime prevalence in the general population ranging in different studies between 30% and 78%. It has a high socio-economic impact.
While it was previously considered to be primarily psychogenic, a number of studies since ICHD-I strongly suggest a neurobiological basis.

The division of 2. Tension-type headache into episodic and chronic types, introduced in ICHD-I, has proved extremely useful. In ICHD-II, the episodic type was further divided into an infrequent type, with headache episodes less than once per month, and a frequent type. 2.2 Frequent episodic tension-type headache can be associated with considerable disability, and sometimes warrants treatment with expensive drugs. In contrast, 2.1 Infrequent episodic tension-type headache, which occurs in almost the entire population, usually has very little impact on the individual and, in most instances, requires no attention from the medical profession. The distinction of 2.1 Infrequent episodic tension-type headache from 2.2 Frequent episodic tension-type headache thus separates individuals who typically do not require medical management, and avoids categorizing almost the entire population as having a significant headache disorder, yet allows their headaches to be classified. 2.3 Chronic tension-type headache is a serious disease, causing greatly decreased quality of life and high disability.

The exact mechanisms of 2. Tension-type headache are not known. Peripheral pain mechanisms are most likely to play a role in 2.1 Infrequent episodic tension-type headache and 2.2 Frequent episodic tension-type headache, whereas central pain mechanisms play a more important role in 2.3 Chronic tension-type headache. Increased pericranial tenderness is the most significant abnormal finding in patients with any type of 2. Tension-type headache: it is typically present interracially, is exacerbated during actual headache and increases with the intensity and frequency of headaches. Increased tenderness is very probably of pathophysiological importance. ICHD-II therefore distinguished patients with and without such disorder of the pericranial muscles, a subdivision maintained in ICHD-3 to stimulate further research in this area.

Wisdom Wednesday: Migraine Headaches (Part 1)

Migraine is a common disabling primary headache disorder. Many epidemiological studies have documented its high prevalence and socio-economic and personal impacts. In the Global Burden of Disease Study2010 (GBD2010), it was ranked as the third most prevalent disorder in the world. In GBD2015, it was ranked third–highest cause of disability worldwide in both males and females under the age of 50 years.

Migraine has two major types: Migraine without aura is a clinical syndrome characterized by headache with specific features and associated symptoms. Migraine with aura is primarily characterized by the transient focal neurological symptoms that usually precede or sometimes accompany the headache.

This week we will focus on migraine without aura. Previously, called a common migraine, it is a recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or sensitivity to light and sound.

Diagnosis requires a history of at least 5 attacks, lasting 4-72 hours with a least two of the following: unilateral location, pulsating quality, moderate or severe pain, or aggravation by routine physical activity. During the headaches the patient must exhibit nausea and/or vomiting or light and sound sensitivity.

Migraine headache in children and adolescents (aged under 18 years) is more often bilateral than is the case in adults; unilateral pain usually emerges in late adolescence or early adult life. Migraine without aura often has a menstrual relationship. Very frequent migraine attacks are now distinguished as a Chronic migraine. When there is associated medication overuse, both diagnoses, Chronic migraine and Medication-overuse headache, should be applied. Migraine without aura is the disease most prone to accelerate with frequent use of symptomatic medication.

Wisdom Wednesday: U.S. Life Expectancy Down, Overdose and Suicide Rates Up

U.S. life expectancy at birth has declined for the second year in a row, from 78.7 years in 2015 to 78.6 years in 2016, according to the latest CDC data.

Notable increases were observed in drug overdose deaths and suicides. The overdose rate nearly doubled from 2006 to 2016, hitting 19.8 deaths per 100,000. Meanwhile, suicide rates rose steadily among adults aged 25–44 years, reaching 16.9 deaths per 100,000 — higher than the heart disease death rate. Among those aged 15–24 years, suicide became the second leading cause of death in 2016, and among children aged 1–14 years, the rate reached 0.8 per 100,000.

CDC Director Dr. Robert Redfield said in a statement, "These sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable. ... we must all work together to reverse this trend and help ensure that all Americans live longer and healthier lives."

My Take:
In 2016, the top 10 leading causes of death were heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease, and suicide. Metabolic syndrome, a preventable condition is a direct cause in half of the top causes of death.

Wisdom Wednesday: How Coffee Protects the Brain

Scientists have now proved that drinking certain types of coffee can be beneficial to brain health, but how does this popular brew support cognitive function? A new study identifies some the mechanisms that allow coffee to keep mental decline at bay.

According to data from the Harvard T.H. Chan School of Public Health in Boston, MA, about 54% of all adults in the United States drink coffee on a daily basis. While drinking coffee can bring both benefit and risks for a person’s health, a 2016 study from the University of Ulster in Coleraine, United Kingdom, concluded that the health benefits of moderate coffee consumption “clearly outweigh” the potential risks.

“Coffee consumption does seem to have some correlation to a decreased risk of developing Alzheimer’s disease and Parkinson’s disease,” notes Dr. Donald Weaver, co-director of the Krembil Brain Institute which conducted the new study.

Dr. Weaver and team’s findings – published in the journal Frontiers in Neuroscience – suggest that the key to coffee’s brain-protecting benefits lie not in its caffeine content, but in the existence of compounds released in the process of roasting the coffee beans.
It is the phenylindanes, rather than any other coffee-related compounds, that seem to inhibit the amalgamation of tau and beta-amyloid. These are toxic proteins, of which the excessive buildup in the brain is a key factor in the neurodegenerative conditions such as Alzheimer’s and Parkinson’s disease.

It appears that a longer roasting time causes the coffee beans to produce more phenylindanes. This suggests that dark roasted coffee – whether regular or decaf – has the strongest protective effect on the brain.