Dr. Bray Links

Friday, November 15, 2019

ACP Internist: New dietary guidelines ignore science

The federal government has issued dietary guidelines every 5 years since 1980. They are the ones that came out with the food pyramid, and most recently gave limits for sugar, saturated fat, and sodium (salt). These guidelines affect many things, including what children get served for lunch at school.

For the first time ever, the Department of Health and Human Services and the Department of Agriculture, under the direction of the Trump administration, is limiting the scope of the committee. They gave them a list of 80 questions, and said they are not to consider anything outside that list. Those questions do not include health risks such as too much salt, red meat, and processed foods.

The nature of science is that with ongoing research things change. Most of you can probably recall getting conflicting diet recommendations over the years. We were told to avoid fats, as we subsequently got collectively heavier, then ketogenic diets said the opposite. Alcohol can decrease heart disease, then studies showed it can increase breast cancer. That's why it's important to periodically review the literature and adjust recommendations if warranted.

Why would the Trump administration want to limit the committee? For one thing, they have generally been anti-science in many areas, such as global warming. For another, as they say, follow the money. Thirteen out of 20 of the committee members have food industry ties. This compares with two of 12 members in 2015. You can read more details in a Washington Post article.

Health care costs have been going up at a rate higher than inflation for many years. Although there are many reasons for this, part of it is because people are getting more obese. This leads to such health issues as diabetes, hypertension, heart disease, and arthritis. The new rules effectively says that corporate interests trump human health. So that corporations can profit more, we will pay the price in our health, and in our future medical bills.

The statute (Public Law 101-445, 7 U.S.C. 5341 et seq.) that required the guidelines specifically says that the Dietary Guidelines be based on the preponderance of current scientific and medical knowledge. As that wouldn't be the case, unless the restrictions are removed, I expect that from 2020 to 2025 I'll be advising my patients to follow the 2015 guidelines.

http://blog.acpinternist.org/2019/11/new-dietary-guidelines-ignore-science.html

Tuesday, December 25, 2018

Gut microbiota functions: metabolism of nutrients and other food components

Magnusdottir et al. [56] have systematically explored the genomes of 256 common gut bacteria for the presence of biosynthetic pathways for eight B vitamins, namely biotin, cobalamin, folate, niacin, pantothenate, pyridoxine, riboflavin, and thiamin. This allowed the authors to predict the proportion of each phylum containing potential producers of each vitamin. Some genomes contained all eight pathways, others none. The most commonly synthesised vitamins were riboflavin (166 potential producers) and niacin (162 producers). For riboflavin and biotin, virtually all microbes from the phyla Bacteroidetes, Fusobacteria and Proteobacteria possessed the necessary pathways, with a much smaller proportion of the Firmicutes and Actinobacteria having the potential for vitamin B biosynthesis. In the case of vitamin B12, all the Fusobacteria, compared with 10–50% of the other four phyla were predicted to be producers. Overall, Bacteroidetes appeared to be the phylum with the greatest number of predicted B vitamin producers. Excluding vitamin B12, over 90% of Bacteroidetes were predicted to be producers.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847071/#!po=1.82482

The fungal microbiome contributes to alcohol-induced liver damage

Alcoholism contributes to nearly half of liver cirrhosis-related deaths in the United States. Chronic alcohol abuse is also known to alter the intestinal microbiome, a community of bacteria, fungi, and viruses that coexist in the gut and help maintain immunological and metabolic homeostasis. Whether microbial fluctuations contribute to liver disease in chronic alcohol users is unclear, and the effect of changing intestinal fungal populations has not been previously studied.

This week in the JCI, a study led by Bernd Schnabl connects alcohol-driven changes in the fungal microbiome to liver disease. The research team at the University of California San Diego discovered that chronic alcohol intake increased fungal populations in the intestine as well as levels of the fungal structural molecule β-glucan in the bloodstream of mice. The latter result reaffirms prior findings that alcoholism increases the permeability of the intestine and permits gut microbes to leak into circulation. Further investigation revealed that fungal β-glucan activates an immune system receptor called CLEC7A on liver-dwelling immune cells, stimulating a pathway that provokes liver inflammation. Treating mice with anti-fungal agents prevented alcohol-induced fungal overgrowth and reduced signs of liver disease. The findings of this study support further research into the fungal microbiome's role in alcohol-related liver damage.

https://eurekalert.org/pub_releases/2017-05/jj-tfm051617.php

Friday, December 21, 2018

Study links early puberty in girls to chemicals in shampoo, toothpaste and soap – even if only used by mother in pregnancy

Over the past 20 years, research has shown that girls, and possibly also boys, have been going through puberty earlier and earlier. This is troubling news because scientists have linked the early onset of puberty with greater risk of mental illness, breast and ovarian cancer in girls and testicular cancer in boys.

Early puberty, also known as precocious puberty, is defined as developing breasts and starting periods before the age of eight. The average age for girls is 11. Starting before the age of eight also causes social trouble for young girls, including a heightened tendency towards risky behaviour, explains Harley.

The chemicals in question — phthalates, parabens and phenols — are known as endocrine disrupters, which may mimic hormones and lead children to mature well before their natural time. As the study noted, exposure to these chemicals is widespread, which is why it's crucial parents be made aware of the findings.

https://m.scmp.com/news/world/article/2179189/study-links-early-puberty-girls-chemicals-shampoo-toothpaste-and-soap

Gut microbiota composition and functional changes in inflammatory bowel disease and irritable bowel syndrome

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two of the most common diseases of the gastrointestinal tract. In new work, Vich Vila and colleagues have characterized the gut microbiota composition of both disorders using shotgun metagenomic sequencing of stool samples from 1792 individuals. Analyses involving bacterial taxonomy, metabolic functions, antibiotic resistance genes, virulence factors, and bacterial growth rates showed key differences between these two gut disorders. On the basis of gut microbiota composition differences, patients with IBD could be distinguished from those with IBS.

http://stm.sciencemag.org/content/10/472/eaap8914

Thursday, December 20, 2018

Desperately Seeking More Primary Care Docs

A looming public health threat in this country is the primary care physician shortage. It's getting worse; we need to act quickly. According to the Annals of Family Medicine,[1] we're going to need an additional 52,000 primary care doctors by the year 2025.

Primary care is the foundation of preventive healthcare, one of the most complex areas in all of medicine. And good primary care is a surefire way to keep healthcare costs down.

https://www.medscape.com/viewarticle/906520

Monday, December 17, 2018

Study finds chronic fatigue clues in overactive immune response | Reuters

The researchers used a drug known as interferon alpha to create a model of the syndrome and found that patients whose immune response to treatment was hyperactive or exaggerated were more likely to then develop severe fatigue.

"For the first time, we have shown that people who are prone to develop a CFS-like illness have an overactive immune system, both before and during a challenge to the immune system," said Alice Russell of King's College London's Institute of Psychiatry, Psychology & Neuroscience (IoPPN), who led the work. 


https://www.reuters.com/article/us-health-chronicfatigue/study-finds-chronic-fatigue-clues-in-overactive-immune-response-idUSKBN1OG00O

Monday, December 10, 2018

Even When Not In Rome, Eat A Mediterranean Diet To Cut Heart Disease Risk | Kaiser Health News

Once again, your mother was right. You really do need to eat your vegetables. And while you are at it, put down the bacon and pick up the olive oil, because new research supports the contention that switching to a Mediterranean diet could significantly decrease the risk of heart disease.

According to a study published Friday in JAMA Network Open, people who followed this type of diet had 25 percent less risk of developing cardiovascular disease over the course of 12 years.

https://khn.org/news/even-when-not-in-rome-eat-a-mediterranean-diet-to-cut-heart-disease-risk/

Saturday, December 8, 2018

Association of Frequency of Organic Food Consumption With Cancer Risk

Results  Among 68 946 participants (78.0% female; mean [SD] age at baseline, 44.2 [14.5] years), 1340 first incident cancer cases were identified during follow-up, with the most prevalent being 459 breast cancers, 180 prostate cancers, 135 skin cancers, 99 colorectal cancers, 47 non-Hodgkin lymphomas, and 15 other lymphomas. High organic food scores were inversely associated with the overall risk of cancer (hazard ratio for quartile 4 vs quartile 1, 0.75; 95% CI, 0.63-0.88; P for trend = .001; absolute risk reduction, 0.6%; hazard ratio for a 5-point increase, 0.92; 95% CI, 0.88-0.96).

Conclusions and Relevance  A higher frequency of organic food consumption was associated with a reduced risk of cancer. If these findings are confirmed, further research is necessary to determine the underlying factors involved in this association.

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2707948

Ultraviolet and Vitamin D

Reptiles need UVB for biosynthesis of vitamin D, and other metabolic processes. Specifically cholecalciferol (vitamin D3), which is needed to for basic cellular / neural functioning as well as the utilization calcium for bone and egg production. The UVA wavelength is also visible to many reptiles and might play a signifiant role in their ability survive in the wild as well as visual communication between individuals. Therefore, in a typical reptile enclosure, a fluorescent UV a/b source (at the proper strength / spectrum for the species), must be available for many captive species to survive. Simple supplementation with cholecalciferol (Vitamin D3) will not be enough as there's a complete biosynthetic pathway that is "leapfrogged" (risks of possible overdoses), the intermediate molecules and metabolites also place important functions in the animals health. Natural sunlight in the right levels is always going to be superior to artificial sources, but this might be possible for keepers in different parts of the world. 

https://en.m.wikipedia.org/wiki/Ultraviolet

Tuesday, December 4, 2018

The acute and chronic effects of hot water immersion on inflammation and metabolism in sedentary, overweight adults

Regular exercise-induced acute inflammatory responses are suggested to improve the inflammatory profile and insulin sensitivity. As body temperature elevations partly mediate this response, passive heating might be a viable tool to improve the inflammatory profile. This study investigated the acute, and chronic effects of hot water immersion on inflammatory and metabolic markers. Ten sedentary, overweight males (BMI: 31.0±4.2 kg/m2) were immersed in water set at 39°C for 1 h (HWI) or rested for 1 h at ambient temperature (AMB). Venous blood was obtained prior to, immediately post and 2 h post-session for assessment of monocyte intracellular heat shock protein 72 (iHsp72) and plasma concentrations of extracelullar heat shock protein 72 (eHsp72), interleukin-6 (IL-6), fasting glucose, insulin and nitrite. Thereafter, participants underwent a 2-week intervention period, consisting of 10 hot water immersion sessions (INT). Eight BMI-matched participants (BMI: 30.0±2.5 kg/m2) were included as control (CON). Plasma IL-6 and nitrite concentrations were higher immediately following HWI compared to AMB (IL-6 p<0.001, HWI: 1.37±0.94 to 2.51±1.49 pg/ml; nitrite p=0.04, HWI: 271±52 to 391±72 nM), while iHsp72 expression was unchanged (p=0.57). In contrast to resting iHsp72 expression (p=0.59), fasting glucose (p=0.04, INT: 4.44±0.93 to 3.98±0.98 mmol/l), insulin (p=0.04, INT: 68.1±44.6 to 55.0±29.9 pmol/l) and eHsp72 (p=0.03, INT: 17±41% reduction) concentrations were lowered after INT compared to CON. HWI induced an acute inflammatory response and increased nitric oxide bioavailability. The reductions in fasting glucose and insulin concentrations following the chronic intervention suggest that hot water immersion may serve as a tool to improve glucose metabolism.

https://www.physiology.org/doi/abs/10.1152/japplphysiol.00407.2018

Sunday, December 2, 2018

Patients Often Withhold Information From Providers

The most common situations in which information was withheld were not agreeing with the clinician's recommendation (MTurk, 45.7%; SSI, 31.4%) and not understanding the clinician's instructions (MTurk, 31.8%; SSI, 24.3%).

The five reasons most commonly indicated for participants not disclosing information were not wanting to be judged or lectured (MTurk, 81.8%; SSI, 64.1%), not wanting to hear how harmful their behavior is (MTurk, 75.7%; SSI, 61.1%), embarrassment (MTurk, 60.9%; SSI, 49.9%), not wanting the clinician to think they were difficult patients (MTurk, 50.8%; SSI, 38.1%), and not wanting to take up more of the clinician's time (MTurk, 45.2%; SSI, 35.9%).

"If patients are withholding information from clinicians as frequently as this research suggests, then clinicians are routinely not receiving the information that they need to provide high quality care to patients, especially sicker patients," the researchers conclude. They note that sicker patients were more likely to withhold information.

https://www.medscape.com/viewarticle/905825

Saturday, December 1, 2018

A novel hypothesis for atherosclerosis as a cholesterol sulfate deficiency syndrome

Worldwide geographical data show an inverse relationship between cardiovascular disease and annual sunlight availability [18]. In a study conducted in the British Isles, 49 % of the variance in mortality from coronary heart disease was accounted for by mean annual sunshine hours as measured by the Meteorological Office [19]. However, placebo-controlled trials failed to show any benefit from vitamin D3 supplementation [20]. We propose that the benefit comes from Ch-S synthesis instead. In [16], it was proposed that the protein endothelial nitric oxide synthase (eNOS), along with sunlight, catalyzes sulfate production in erythrocytes, endothelial cells, platelets and keratinocytes in the skin. Thus, eNOS is a dual-purpose enzyme, producing sulfate when it is membrane–bound and producing nitric oxide when it is free in the cytoplasm. We hypothesize that the overuse of sunscreen has played a dual damaging role not only because sunlight catalysis is suppressed but also because the aluminum found in high-SPF sunscreens as an emulsifier actively disrupts eNOS' function [21]. eNOS is an orphan cytochrome P450 (CYP) enzyme [22], and aluminum is a known disruptor of CYP enzyme function through its displacement of the iron in the heme group [23]. Many other environmental toxicants also disrupt CYP enzymes, including mercury [24, 25], arsenic [26], cadmium [24], glyphosate [27, 28], and lead [25, 29].

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456713/

Wednesday, November 28, 2018

Can Diet Reverse Type 2 Diabetes?

Unlike in DiRECT, patients were allowed to take insulin at study onset (30% in the low-carbohydrate group and 46% in the usual care group). After 1 year, patients in the usual care group had no significant changes in study biomarkers.

Conversely, 60% of those in the low-carbohydrate group achieved an A1c level < 6.5 while taking no diabetes medications or metformin only. There was also a 12% weight loss, 24% reduction in triglyceride level, 18% increase in high-density lipoprotein cholesterol level, and 39% reduction in C-reactive protein level.

According to Sarah Hallberg, DO, the study's principal investigator and medical director of Virta Health and Indiana University Arnett's Medically Supervised Weight Loss Program, the 94% rate of reduction or outright cessation of insulin in this group is particularly noteworthy.

https://www.medscape.com/viewarticle/905409

Sunday, November 25, 2018

Report: Toxic herbicide found in many Texans' drinking water | The Texas Tribune


Nearly 500 water utilities across the state tested positive for atrazine — a weed killer — which can lead to harmful health effects, according to a new report. The Environmental Working Group also found that utilities are testing water during times when the herbicide isn't being used as much — and that they may be lowballing the results.


https://www.texastribune.org/2018/11/15/report-toxic-herbicide-found-many-texans-drinking-water/

The Real Scoop on the Latest Low-Carb Diet Study

Those in the low-carb-diet group had significantly higher total energy expenditure than those in the other groups. They were burning about 209 calories per day more than the high-carb group.

https://www.medscape.com/viewarticle/904963

Tuesday, November 20, 2018

This Inventor May Have Cured Motion Sickness Without Drugs. And That Could Mean a Lot to the US Military - Defense One

The vibrations emanating from the OtoTech gently target two of the four fibers that carry data about body motion to the brain via a system of inner ear sensors called the vestibulocochlear nerve. "Two [of the four vestibulocochlear nerve fibers] go to the brain, two go to your reflexes," Owen said. The trick is to affect the former and not the latter.

"The working hypothesis is that [the vibration] causes a chaotic and noninformative stimulus to go to the brain. Somewhere, probably the cerebellum, there's a filtering mechanism that filters out noninformative sensed information. It's the reason you don't notice the shirt on your back right now," he said.

https://www.defenseone.com/technology/2018/11/inventor-may-have-cured-motion-sickness-without-drugs-and-could-mean-lot-us-military/152960/

Sunday, November 18, 2018

Death of HHS official Daniel Best is ruled a suicide

The Nov. 1 death of Daniel Best, a pharmaceutical executive from Bay Village who led U.S. Department of Health and Human Services efforts to lower prescription drug prices, has been ruled a suicide, officials in Washington, D.C., said Thursday.

Police say Best was found "unresponsive" near the garage door exit of an apartment building in Washington, D.C.'s Navy Yard neighborhood at 5:25 a.m. on Nov. 1, and was pronounced dead by medical personnel who responded to the scene.

The city's Office of the Chief Medical Examiner on Thursday said Best died from "multiple blunt force injuries" and it ruled his death a suicide. It would not release further information.

http://12160.info/m/discussion?id=2649739%3ATopic%3A1847383