Dr. Bray Links

Friday, February 23, 2018

Health care’s fundamental problem: Your doctor doesn’t work for you | TheHill

Once the backbone of America's health care system, primary care physicians have been overtaken by medical middlemen that drive up costs and get between doctors and our patients. Every step of the way, the patient's interests are subordinated to another customer. Doctors answer to their hospital employers. The hospitals are eager to please the insurance companies that decide whether to pay medical claims.


Throughout its history, the health insurance industry has paid lip service to controlling costs while actually driving them higher. At any time, your doctor's years of training and knowledge of your unique condition can be vetoed by your insurance company. By overriding a doctor's recommendation, a patient's condition can deteriorate and lead to more costly procedures. 

http://thehill.com/opinion/healthcare/375348-health-cares-fundamental-problem-your-doctor-doesnt-work-for-you

CMS Wants in on Direct Primary Care (Healthcare Blog) | Medpage Today

Just as the direct primary care movement to take insurers and government intermediaries out of medicine gains traction, the Centers for Medicare and Medicaid Services is getting involved, one proponent writes for The Healthcare Blog.

There are 770 direct primary care clinics in the country, Niran Al-Agba, MD, writes. But as the movement grows, CMS is edged out. Now, the agency is holding focus groups in four cities, asking how it can get involved.

At best, Al-Agba said, that's patronizing.

"The DPC movement offers the first successful and innovative alternative healthcare approach to emerge in years," he writes. "Make no mistake, CMS is the enemy of independent physicians everywhere and our best defense is to have a good offense – leading with transparency to our patients and the public. "

https://www.medpagetoday.com/practicemanagement/practicemanagement/71252

Wednesday, February 21, 2018

The Key to Weight Loss Is Diet Quality, Not Quantity, a New Study Finds

Anyone who has ever been on a diet knows that the standard prescription for weight loss is to reduce the amount of calories you consume.

But a new study, published Tuesday in JAMA, may turn that advice on its head. It found that people who cut back on added sugar, refined grains and highly processed foods while concentrating on eating plenty of vegetables and whole foods — without worrying about counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.

The strategy worked for people whether they followed diets that were mostly low in fat or mostly low in carbohydrates. And their success did not appear to be influenced by their genetics or their insulin-response to carbohydrates, a finding that casts doubt on the increasingly popular idea that different diets should be recommended to people based on their DNA makeup or on their tolerance for carbs or fat.

https://mobile.nytimes.com/2018/02/20/well/eat/counting-calories-weight-loss-diet-dieting-low-carb-low-fat.html

Monday, February 19, 2018

Advanced glycation endproducts, dityrosine and arginine transporter dysfunction in autism



Changes in plasma AGEs were likely indicative of dysfunctional metabolism of dicarbonyl metabolite precursors of AGEs, glyoxal and 3-deoxyglucosone. DT is formed enzymatically by dual oxidase (DUOX); selective increase of DT as an oxidative damage marker implicates increased DUOX activity in ASD possibly linked to impaired gut mucosal immunity. Decreased renal clearance of arginine and CMA in ASD is indicative of increased arginine transporter activity which may be a surrogate marker of disturbance of neuronal availability of amino acids. Data driven combination of these biomarkers perturbed by proteotoxic stress, plasma protein AGEs and DT, gave diagnostic algorithms of high sensitivity and specificity for ASD.

https://molecularautism.biomedcentral.com/articles/10.1186/s13229-017-0183-3

Acetaminophen Use Alters Sex Hormones, May Cause Birth Defects?



"The surprising thing that we observed in people who were taking acetaminophen (paracetamol) was that all of them had a peculiar profile in hormone metabolites," senior author Amalio Telenti, MD, from J Craig Venter  Institute, in La Jolla, California, explained to Medscape Medical News.

The researchers speculated that they might find liver dysfunction with large doses of acetaminophen, "because that is normal toxicity," but surprisingly they found that acetaminophen was associated with changes in certain hormonal metabolites.

For example, the effect of taking acetaminophen on pregnen-diol disulfate was roughly equivalent to the effect of 35 years of aging, or the normal decrease in levels seen in menopause.

https://www.medscape.com/viewarticle/892824

New C difficile Guidelines Refine Diagnosis, Add FMT

The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America have updated the 2010 clinical practice guidelines on Clostridium difficile infection (CDI) in adults.

The update adds recommendations for children, refines combinations and sequences of diagnostic tests, and changes antibiotic choices. It also, for the first time, includes guidance for implementing fecal microbiota transplantation (FMT). The guidelines are published in Clinical Infectious Diseases.

https://www.medscape.com/viewarticle/892813

Ketogenic Drinks Improve Glycemia and Insulin Sensitivity

A ketone supplement, taken as a so-called 'keto drink' half an hour prior to consuming glucose, reduces glycemic response and improves markers of insulin sensitivity without affecting insulin secretion, show data from a small randomized cross-over study in healthy volunteers.

According to the authors, led by Étienne Myette-Côté, PhD candidate, from the University of British Columbia Okanagan, Kelowna, Canada, "ketone monoester supplements could have therapeutic potential in the management and prevention of metabolic disease." The article was published online February 15 in the Journal of Physiology.

https://www.medscape.com/viewarticle/892829

Friday, February 16, 2018

Adult endothelial stem cells can make fully functional blood vessels

"Our findings show that CD157-positive vascular endothelial stem cells give rise to a hierarchy of cell types that can repair vascular injury and maintain the normal blood vessel architecture," Takakura says. "We believe these findings represent an entirely new way of thinking about how blood vessels are formed and, ultimately, how stem cells can be used to treat disorders related to blood vessel malfunction."

https://www.sciencedaily.com/releases/2018/02/180215105734.htm

Thursday, February 15, 2018

Ultra-processed foods 'linked to cancer' - BBC News

What counts as ultra-processed

    Mass-produced packaged breads and buns
    Sweet or savoury packaged snacks including crisps
    Chocolate bars and sweets
    Sodas and sweetened drinks
    Meatballs, poultry and fish nuggets
    Instant noodles and soups
    Frozen or shelf-life ready meals
    Foods made mostly or entirely from sugar, oils and fats

http://www.bbc.com/news/health-43064290

Wednesday, February 14, 2018

Chemicals in packaging, carpets and non-stick pans 'may contribute to obesity'

Chemicals used to make non-stick pots and pans, stain-resistant carpets, and food packaging may contribute to high levels of obesity by disrupting the body's ability to burn calories, scientists say.

Researchers at Harvard University examined the effects of compounds called perfluoroalkyl substances (PFASs), which have already raised concerns among some health experts after animal experiments and other studies linked them to cancer, high cholesterol and immune problems.

In the latest work, Qi Sun, a nutritionist who specialises in the risk factors for diabetes, obesity, and cardiovascular disease, analysed records for 621 overweight and obese people who spent six months dieting. All were part of a clinical trial run in the 2000s to test the effectiveness of different types of diets.


https://www.theguardian.com/science/2018/feb/13/chemicals-in-packaging-carpets-and-non-stick-pans-may-contribute-to-obesity

Monday, February 12, 2018

Prescription Opioids Increase Risk for Serious Infections



Animal studies have shown that some opioid medications have immunosuppressive effects. The drugs interfere with the production of bacteria-killing immune cells, reduce the innate immune response, and inhibit the production of antibodies and cytokines. Previous human studies have shown that opioid medications increase the risk for infection in hospitalized patients after surgery or during treatment for burns or cancer. Other studies suggest an increased risk for serious infections in certain high-risk outpatients.

Now, the new study strengthens the evidence that the immune-suppressing effects of opioids extend to humans.

"[W]e found that current opioid use was strongly and consistently associated with the risk for [invasive pneumococcal disease (IPD),] and that the association was strongest for long-acting and high-potency formulations, opioids previously described as immunosuppressive, and high-dose opioids," write Andrew Wiese, PhD, from the Department of Health Policy at Vanderbilt University Medical Center, Nashville, Tennessee, and colleagues.

https://www.medscape.com/viewarticle/892586

Saturday, February 10, 2018

Inexpensive Technology Can Spot Fake Organic Milk – Will the USDA Look? - Cornucopia Institute

How much fresh grass did the "grass-fed" cows who make your milk eat? A team of scientists from Iowa State University's Leopold Center for Sustainable Agriculture has found a new technique they say can determine exactly that. Their findings, reported in The Journal of Agricultural and Food Chemistry last month, suggest that fluorescence spectroscopy—a relatively cheap and simple form of light measurement—could be a way to assure shoppers about "grass-fed" claims in the supermarket. And it could prove to be an important tool for transparency in the organic dairy sector, where cows are required to spend time foraging outdoors—something critics allege doesn't always happen.


https://www.cornucopia.org/2018/02/inexpensive-technology-can-spot-fake-organic-milk-will-usda-look/#more-44857

Many people take dangerously high amounts of ibuprofen | Fox News

Many adults who use ibuprofen and other so-called nonsteroidal anti-inflammatory (NSAID) drugs take too much, increasing their risk of serious side effects like internal bleeding and heart attacks, a U.S. study suggests.

About 15 percent of adults taking ibuprofen (Motrin, Advil) or other NSAIDs like aspirin, naproxen (Aleve), celecoxib (Celebrex), meloxicam (Mobic) and diclofenac (Voltaren) exceeded the maximum recommended daily dose for these drugs, the study found.

"NSAIDs are among the most commonly used medicines in the U.S. and worldwide," said lead study author Dr. David Kaufman of Boston University.

"These drugs can have serious side effects, including gastrointestinal bleeding and heart attacks, and are often taken without medical oversight because many products are available over-the-counter," Kaufman said by email. "The attitude that users can choose their own dose regardless of label directions, along with poor knowledge of dosing limits, is associated with exceeding the daily limit."

http://www.foxnews.com/health/2018/02/08/many-people-take-dangerously-high-amounts-ibuprofen.html

Zeroing in on FODMAPs - C&EN Global Enterprise

"In healthy individuals, FODMAPs may cause a little more flatulence, but not pain, diarrhea, and bloating," says William Chey, a gastroenterologist at the University of Michigan who studies the low FODMAP diet. FODMAPs also trigger abnormalities in how IBS patients' bowels function, Chey adds. For example, their colons may be hyperactive after a meal, and FODMAPs might exacerbate that activity.
FODMAPs also seem to influence the microbes living inside the gut. Recently, a team led by Chung Owyang, another gastroenterologist at the University of Michigan, reported that FODMAPs promote the overgrowth of Gram-negative bacteria in the gut. These bacteria have cell walls that contain lipopolysaccharides, a group of molecules that can inflame the intestinal lining (J. Clin. Invest. 2017, DOI: 10.1172/JCI92390).
Owyang says his group is now starting to identify the specific Gram-negative bacteria that are richest in lipopolysaccharides. "Perhaps we can come up with ways to decrease the growth of those particular bacteria," he says.
Meanwhile, Chey's patients commonly tell him that ingesting various types of food causes their gastrointestinal (GI) problems. "You would think just logically based upon what patients have been telling us for many, many years that there would be many evidence-based diet strategies for patients with GI problems," he says. "Curiously, that has not been the case until probably the last 10 years or so."
Chey says he first learned about the low FODMAP diet in 2008 after reading a paper from Gibson and the rest of the Monash University team (Clin. Gastroenterol. Hepatol. 2008, DOI: 10.1016/j.cgh.2008.02.058). The following year, Chey gave a talk during a postgraduate course for gastroenterologists in the U.S. and asked how many of the gathered doctors had heard of FODMAPs. "Out of an audience of several thousands, fewer than half a dozen hands went up," he recalls. "People had just never even heard of this concept."
He repeated the informal survey at a similar course in 2017. "Probably 80% of the hands went up," he says. And 60% of the doctors said they were using the low FODMAP diet in their clinical practice. In just nine years, he says, the dietary treatment has become wildly popular.


https://pubs.acs.org/doi/full/10.1021/cen-09606-cover?ref=PubsWidget

Friday, February 9, 2018

Bacteriophages Plentiful in Women’s Bladders

 The researchers identified more than 450 possible phage sequences within the majority of the nearly 200 bacterial genomes that they examined. More than half of these viral sequences were not found in any databases, suggesting that they could be phages unique to the urinary tract.

"We find this time and time again," James says. "In all of the niches, there's so little known about viruses that every time you sequence any viral community, there's always a massive amount of novelty. It highlights how much we still don't know."

https://mobile.the-scientist.com/article/51548/bacteriophages-plentiful-in-women-s-bladders

Think Beyond the Bladder for Interstitial Cystitis/Bladder Pain Syndrome

PVD can result from hormonal changes, inflammation, neurological factors, and hypertonic pelvic floor muscles. Deficiency in testosterone is especially common, mostly in younger women receiving oral contraceptives and in menopausal women. Pelvic muscle health is also a big factor. When pelvic floor muscles are tight and overactive, pain can be referred to the vestibule, and this can mimic bladder pain symptoms, she said.

"The pelvis is a bowl of muscles holding the bladder up. If it's irritated, it causes the bladder 'next door' to sense pain," she said. "But it's not actually the bladder that has problem; it's the tissue around and nearby the bladder that's the problem."

https://www.medscape.com/viewarticle/887862

Thursday, February 8, 2018

Mental health: Living with Borderline Personality Disorder - BBC News

A psychiatrist I was referred to then diagnosed Borderline Personality Disorder, otherwise known as emotional instability.

I had never heard of this, but when I looked up the symptoms, I had them all.

They included struggling to maintain stable relationships, having suicidal thoughts and intense emotions that would change rapidly.

Then there was acting impulsively, feeling paranoid and suffering intense outbursts of anger. 

http://www.bbc.com/news/uk-wales-42861224

Food may influence cancer spread - BBC News



There is mounting evidence the food on your plate can alter cancer's growth and spread, say Cambridge scientists.

Animal research, published in the journal Nature, showed breast tumours struggled without the dietary nutrient asparagine.

It is found in the foodies' favourite asparagus, as well as poultry, seafood and many other foods.

In the future, scientists hope to take advantage of cancer's "culinary addictions" to improve treatment.

Asparagine is an amino acid - a building block of protein - and takes its name from asparagus. 

http://www.bbc.com/news/health-42976851

Wednesday, February 7, 2018

Largest Animal Study of Cell Phone Radiation and Cancer Risk

Specifically, exposure to Global System for Mobile Communications (GSM)–modulated or to Code Division Multiple Access (CDMA)–modulated cell phone RFR was associated with an increase in the incidence of malignant schwannoma in the heart of male rats.

There was also a significant increase in incidence of right ventricular cardiomyopathy in both male and female rats exposed to 3 watts per kilogram (W/kg) and 6 W/kg of GSM-modulated RFR, and in male rates exposed to 6 W/kg of CDMA-modulated RFR.

The researchers also observed other, albeit weaker, effects for both modulations that included malignant glioma in the brain, adenomas in the pituitary gland (pars distalis), and pheochromocytomas of the adrenal medulla.

In addition, marginal effects were seen for GSM-exposed male rats in the prostate gland and in pancreatic islets, and granular cell tumors of the brain were observed. Such effects were not observed in CDMA-exposed rats. Conversely, liver effects were noted only in CDMA-exposed male rats, although the relationship between these responses and exposure to GSM or CDMA RFR remains unclear.

https://www.medscape.com/viewarticle/892346

Vitamin D improved asthma symptoms and reduced exacerbations - PulmCCM

Multiple randomized trials have suggested that vitamin D supplementation might improve asthma control and reduce severity of asthma attacks. A new meta-analysis bolsters that hypothesis, and may encourage more physicians and people with asthma to consider vitamin D supplements for low vitamin D levels.

In a study in Lancet Respiratory Medicine, authors analyzed the experience of 955 asthma patients previously enrolled in seven randomized controlled trials testing vitamin D versus placebo.

Supplementation with vitamin D was associated with a 50% reduction in asthma attacks severe enough to require hospitalization or emergency department visit (3% vs 6%), compared to placebo. Vitamin D use was also associated with a 30% reduction in asthma attacks necessitating 

https://pulmccm.org/asthma-review/vitamin-d-improved-asthma-symptoms-reduced-exacerbations/