Dr. Bray Links

Thursday, November 16, 2017

Amish Mutation Protects Against Diabetes and May Extend Life - NYTimes.com

Amish people living in a rural part of Indiana have a rare genetic mutation that protects them from Type 2 diabetes and appears to significantly extend their life spans, according to a new study.

The findings, published on Wednesday in the journal Science Advances, shed light on the processes underlying cellular aging and could lead to new therapies for chronic diseases, some experts say. The researchers are planning at least one follow-up trial that will recreate the effects of the mutation so they can study its impact on obese people with insulin resistance, a precursor to diabetes.

The mutation described in the new paper affects a mysterious protein called plasminogen activator inhibitor-1, or PAI-1, that is known primarily for its role in promoting blood clotting. The mutation was first identified in 1991 in a secluded Amish farming community in Berne, Ind. An estimated 5 percent of the community carries the mutation, which causes them to produce unusually low levels of PAI-1.

Scientists have long suspected that PAI-1 has other functions outside of clotting that relate to aging. Dr. Douglas Vaughan, a cardiologist at Northwestern medical school, noticed, for example, that mice that had been genetically engineered to produce high levels of the protein age fairly quickly, going bald and dying of heart attacks at young ages. People who have higher levels of the protein in their bloodstreams also tend to have higher rates of diabetes and other metabolic problems and to die earlier of cardiovascular disease.

https://mobile.nytimes.com/2017/11/15/well/live/amish-mutation-protects-against-diabetes-and-may-extend-life.html

Monday, November 13, 2017

Mortality Lower When Inpatients See Their Own PCP in Hospital

A primary care physician (PCP)'s prior knowledge of a patient has a significant effect on outcomes when that patient is hospitalized, data from a new study suggest.

In a retrospective analysis of more than 560,000 Medicare patients, hospital care by a PCP who had previously seen the individual as an outpatient was associated with a greater chance of being discharged home and a lower 30-day mortality compared with care delivered by a hospitalist or other generalist who had never met the patient before, Jennifer P. Stevens, MD, MS, and colleagues report today in JAMA Internal Medicine.

These findings may be especially important for patients with multiple illnesses and those who require a complex level of care, Seth Landefeld, MD, coauthor of an accompanying editorial, said in an interview with the journal.

https://www.medscape.com/viewarticle/888520

Saturday, November 11, 2017

Mitochondrial Networks Explain Why Caloric Restriction Extends Worms’ Lives | The Scientist Magazine(R)

 "Low-energy conditions such as dietary restriction and intermittent fasting have previously been shown to promote healthy aging," lead author Heather Weir, who conducted the research while at Harvard T. H. Chan School of Public Health and is now a research associate at Astex Pharmaceuticals, tells the Harvard Gazette. "Understanding why this is the case is a crucial step toward being able to harness the benefits therapeutically."

Mitochondria exist in networks that alternate between "fused" and "fragmented" states, which affect how the organelles process energy. This dynamic fission and fusion of mitochondria has been linked to aging, and the new study provides two key players—AMPK and peroxisomes—in orchestrating those fluctuating connections and their effect on organismal health and senescence. 

"Although previous work has shown how intermittent fasting can slow aging, we are only beginning to understand the underlying biology," senior author William Mair, associate professor of genetics and complex diseases at Harvard Chan School, tells the Harvard Gazette. "Our work shows how crucial the plasticity of mitochondria networks is for the benefits of fasting. If we lock mitochondria in one state, we completely block the effects of fasting or dietary restriction on longevity."

http://mobile.the-scientist.com/article/50886/mitochondrial-networks-explain-why-caloric-restriction-extends-worms-lives

Friday, November 10, 2017

New Study Shows Antioxidant-Rich Foods Diminish Diabetes Risk

Consuming a diet rich in antioxidant foods may help decrease the risk of type 2 diabetes, according to a new study published November 9 in Diabetologia.

The trial is the first prospective investigation into the link between total antioxidant consumption and risk of type 2 diabetes, say the researchers.

"This work complements our current knowledge of the effect of isolated foods and nutrients and provides a more comprehensive view of the relationship between food and type 2 diabetes," senior author Guy Fagherazzi, PhD, of the University Paris-Sud, Villejuif Cedex, France, said in a press release.

Prior research has suggested that oxidative stress may contribute to the development of type 2 diabetes. While some studies have found that the antioxidant vitamin E may help decrease the risk of type 2 diabetes, others have not confirmed this effect for the antioxidants vitamin C, flavonoids, and lycopene.

https://www.medscape.com/viewarticle/888350

Wednesday, November 8, 2017

Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy — NEJM

Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio.

http://www.nejm.org/doi/full/10.1056/NEJMsa065779

How Has the Physician-Patient Relationship Changed?

We know from [our experiences from] the early 1970s to now that talking about your dissatisfaction by itself doesn't lead to meaningful change. We need physicians and providers, people who work in the practice, as well as patients, to be willing to make change at a grassroots level. We need to stop looking for a silver bullet from either the government or health insurers to fix healthcare. We need to take that burden on ourselves.

If people say, "I will shift to doctors who spend time with me; I will shift my health insurance to places that treat me like a person and not like a number," then we will see a shift. The thing that is helping people is that more of the healthcare dollar—how much we pay for healthcare—is being shifted to people, and so they can vote with their dollars.

https://www.medscape.com/viewarticle/887853

Tuesday, October 31, 2017

What to Do When Patients Don't Heed Your Advice

The overwhelming majority of my patients act with good sense. Nevertheless, the confusion of preexisting patient conclusions and the use of self-validating search engine searches as a substitute for either research or offered wisdom and experience are seemingly on the rise. It is human nature to seek confirmation bias. However, we've been a nation that has sought education and knowledge, and celebrated wisdom. Increasingly, I've seen the consequences of a societal derision of the educated as being uncool and of the wise as unworthy of notice.


https://www.medscape.com/viewarticle/881711_2

Pesticide Residues in Food May Impair Female Fertility

Women undergoing infertility treatment who consumed more high-pesticide residue foods had a lower likelihood of clinical pregnancy and live birth compared with their peers, a new prospective epidemiological study showed.

Compared with women in the lowest quartile of high-pesticide residue fruits and vegetable intake (<1.0 servings/day), women in the highest quartile (≥2.3 servings/day) had an 18% lower probability of achieving a clinical pregnancy (95% confidence interval [CI], 5% - 30%) and a 26% lower probability of having a live birth (95% CI, 13% - 37%).

Moreover, substituting just one serving/day of low-pesticide residue produce for one serving/day of high-pesticide residue produce was associated with 79% higher odds of clinical pregnancy (95% CI, 11% -188%) and 88% higher odds of live birth (95% CI, 16% - 205%).

"These data suggest that dietary pesticide exposure within the range of typical human exposure may be associated with adverse reproductive consequences," write Yu-Han Chiu, MD, ScD, from the Department of Nutrition and the Department of Epidemiology at Harvard T.H. Chan School of Public Health in Boston, Massachusetts, and colleagues.

https://www.medscape.com/viewarticle/887794

Acupuncture for Chronic Pain: Unprecedented Advances

The last two decades have seen "unprecedented advances" in the use of acupuncture to treat pain conditions, with a "rapid rise" in the number and quality of related published studies, according to a physician who is an experienced acupuncture practitioner.

"Right now, we have a pretty solid foundation for the efficacy of acupuncture" for headache, osteoarthritis (OA), and musculoskeletal conditions, said Farshad M. Ahadian, MD, clinical professor of anesthesiology, University of California, San Diego.

"I think it's fair to say that acupuncture is here to stay. It's going to be a permanent addition to our tool box."

Dr Ahadian presented the data here at the Academy of Integrative Pain Management (AIPM) 28th Annual Meeting.

https://www.medscape.com/viewarticle/887754

Maternal Use of Acetaminophen Linked to ADHD in Kids

A pregnant woman's use of acetaminophen may be associated with an increase in her child's risk for attention-deficit/hyperactivity disorder (ADHD), the authors of a large, prospective study report.

"[L]ong-term acetaminophen use during pregnancy is related to more than a twofold increase in risk for offspring ADHD," after adjusting for genetic risk factors, indications for the mother's acetaminophen use, use of the drug before pregnancy, and other potential confounders, lead author Eivind Ystrom, PhD, and colleagues write in an article published online today and in the November issue of Pediatrics.

https://www.medscape.com/viewarticle/887773

Thursday, October 12, 2017

$200 Million Gift Could Transform This School's Medical Training

When Susan and Henry Samueli gave $200 million to UC Irvine's College of Health Sciences in late September, they set the stage for a first-of-its-kind educational institution: The Susan and Henry Samueli College of Health Sciences will be the first university-based health sciences enterprise to incorporate integrative health teaching, patient care and research across its schools and programs, according to a university press release.

"Integrative health redefines the relationship between the practitioner and patient by focusing on the whole person and the whole community," the release noted.

"It is informed by scientific evidence and makes use of all appropriate preventatives, therapeutic and lifestyle approaches, and health care professionals and disciplines to promote optimal health and wellness."

https://www.massagemag.com/irvine-integrative-health-program-86917/

Tuesday, October 10, 2017

Quercetin alleviates generalized hyperalgesia in mice with induced adenomyosis

The results demonstrated that treatment with quercetin improved the generalized hyperalgesia by extending the hotplate response latency, reduced myometrial infiltration and decreased the expression levels Trpv‑1, p‑p38 and p‑ERK in dorsal root ganglion neurons. The results indicated that quercetin decreases the incidence of hyperalgesia in mice with tamoxifen‑induced adenomyosis, and the potential mechanism is through reduced central sensitization, which may be a promising treatment for adenomyosis.

https://www.ncbi.nlm.nih.gov/m/pubmed/28849202/?i=3&from=Tamoxifen%20endometrial

Monday, October 9, 2017

Prescribing Pitfalls in Heart Failure With Comorbidities



Interest in the popular supplement coenzyme-Q10 (CoQ10) in heart failure stems in part from its biochemical role in mitochondria, antioxidant effects, and cell-membrane integrity, plus the observation that its levels are reduced in HF patients[4], Chow said.

Clinical trials of CoQ10 in heart failure include a 1993 study with 641 patients in NYHA class 3–4 on medical therapy that was standard for the time[5]. The supplement was associated with significantly reduced risk of HF hospitalization (P<0.001).

Much more recently, the Q-SYMBIO trial randomized 420 patients with NYHA class 3–4 heart failure to receive the supplement or placebo for 2 years on top of standard care, which included ACE inhibitors in 90% and beta-blockers in 72%[6].

Risk of the primary end point (worsening HF, CV death, implantation of a mechanical assist device, or urgent heart transplantation) declined by about half on the supplement (HR 0.50, 95% CI 0.32–0.80; P=0.003). The mortality risk alone went down 42%.

http://www.medscape.com/viewarticle/886762

Woman loses sight in one eye after marathon session playing Honour of Kings on her mobile phone

A doctor was quoted as saying that retinal artery occlusion was a condition associated with elderly people and rarely seen in the young, adding that the woman's blindness was most likely caused by severe eye strain.

http://m.scmp.com/news/china/society/article/2114214/chinese-woman-loses-sight-one-eye-after-marathon-session-playing

Saturday, October 7, 2017

Association Reported Between Fluoride and Reduced IQ

A mother's exposure to fluoride during pregnancy could lower the intelligence of her children, researchers say.

Following a group of Mexican children from the time of their mother's pregnancy to early adolescence, an international team of researchers found an association between high fluoride levels in the mothers' urine and reduced scores on the children's cognitive tests.

http://www.medscape.com/viewarticle/886379

Thursday, October 5, 2017

PPIs Not Superior to Dietary Intervention for Reflux

A primarily plant-based, Mediterranean-style diet with alkaline water showed significantly greater improvement for laryngopharyngeal reflux (LPR) symptoms than treatment with proton-pump inhibitors (PPIs), according to a retrospective study published September 7 in JAMA Otolaryngology–Head & Neck Surgery. 

"This study indicates that, by supplementing with alkaline water and a Mediterranean-style diet, effective control of symptoms as defined by the RSI [Reflux Symptom Index] may be obtained without PPI use," write Craig H. Zalvan, MD, from New York Medical College in Valhalla, and colleagues. "Other benefits of this diet-based approach include decreased risk for and improved control of cardiovascular disease, diabetes, stroke, and cancer, and avoiding the risks of drug interaction or complication."

The researchers retrospectively analyzed the medical records of two cohorts from different timeframes who received different treatments for LPR. One cohort of 85 patients, from 2010 to 2012 with a median age of 60 years, took esomeprazole twice daily or dexlansoprazole daily. They also followed standard reflux dietary precautions, including avoiding coffee; tea; chocolate; soda; alcohol; and greasy, fried, fatty, and spicy foods.

The other cohort, 99 patients from 2013 to 2015 with a median age of 57 years, received alkaline water and a 90% plant-based Mediterranean-style diet in addition to standard reflux precautions. (The water had a pH above 8.0.) Patients with potentially confounding comorbidities, such as a cough, a history of neuropathic pain, or dysphonia, were excluded.

The researchers compared the change in RSI scores between the two groups after 6 weeks of treatment. Among those taking PPIs, 54.1% of the patients had at least a 6-point reduction in their RSI, the minimum improvement deemed clinically meaningful. The average reduction in RSI across the group was 27.2%.

Meanwhile, 62.6% of those receiving the alkaline water and diet had a meaningful improvement in their RSI (difference between the groups, 8.05; 95% confidence interval [CI], –5.74 to 22.76). This group had a 39.8% average reduction in RSI (difference between groups, 12.1; 95% CI, 1.53 - 22.68).

http://www.medscape.com/viewarticle/885356

Wednesday, October 4, 2017

Las Vegas shooter Stephen Paddock was taking psychiatric medications that increase killing behavior by 45%

Records from the Nevada Prescription Monitoring Program obtained Tuesday show Paddock was prescribed 50 10-milligram diazepam tablets by Henderson physician Dr. Steven Winkler on June 21.
A 45% increase in "killing" behavior

Diazepam is a known to promote violent behavior and psychotic episodes. Via the Las Vegas Review-Journal:

"If somebody has an underlying aggression problem and you sedate them with that drug, they can become aggressive," said Dr. Mel Pohl, chief medical officer of the Las Vegas Recovery Center. "It can disinhibit an underlying emotional state. … It is much like what happens when you give alcohol to some people … they become aggressive instead of going to sleep."

Pohl, who spoke to the Review-Journal from the Netherlands, said the effects of the drug also can be magnified by alcohol.

A 2015 study published in World Psychiatry of 960 Finnish adults and teens convicted of homicide showed that their odds of killing were 45 percent higher during time periods when they were on benzodiazepines.

https://www.naturalnews.com/2017-10-04-breaking-las-vegas-shooter-stephen-paddock-was-taking-psychiatric-medications-that-increase-killing-behavior-by-45.html

Monday, October 2, 2017

Arthritis pill: Daily intake halts disabling bone loss and damage

"This drug heralds a new dawn in the treatment of this disease as it is the first evidence we have of a drug which can have a significant benefit on the structure of the bone."

Professor Conaghan, previously chairman of the National Institute for Health and Care Excellence group on the management of osteoarthritis, added: "We now need larger studies to replicate these findings, the results of which we hope will open up a new class of drug."

The treatment, known as M1V-711, is based on a molecule involved in the turnover of bone and cartilage in the joints. It works by interfering with the process that leads to joint breakdown.

It was tested against patients given a placebo and after six months those receiving the treatment showed a 65 per cent reduction in bone loss.

Those on the dummy pills showed slight increases in bone loss. The drug, which was shown to have relatively few side effects, also halted cartilage loss, with those on low doses experiencing a 70 per cent reduction in cartilage thickness and those on higher doses showing a slight increase in cartilage thickness. 

http://www.express.co.uk/life-style/health/860834/Arthritis-pill-disabling-bone-loss-and-damage-osteoarthritis-new-treatment

Tuesday, September 26, 2017

Coffee sold in California could carry cancer warning labels | Fox News

A nonprofit group wants coffee manufacturers, distributors and retailers to post ominous warnings about a cancer-causing chemical stewing in every brew and has been presenting evidence in a Los Angeles courtroom to make its case.

The long-running lawsuit that resumed Monday claims Starbucks and about 90 other companies, including grocery stores and retail shops, failed to follow a state law requiring warning signs about hazardous chemicals found everywhere from household products to workplaces to the environment.

At the center of the dispute is acrylamide, a carcinogen found in cooked foods such as French fries that is also a natural byproduct of the coffee roasting process. The coffee industry has acknowledged the presence of the chemical but asserts it is at harmless levels and is outweighed by benefits from drinking coffee.

http://www.foxnews.com/health/2017/09/26/coffee-sold-in-california-could-carry-cancer-warning-labels.html

Saturday, September 23, 2017

Garlic and Heart Disease

RESULTS: Garlic supplementation reduced blood pressure by 7-16 mm Hg (systolic) and 5-9 mm Hg (diastolic) (4 meta-analyses and 2 original studies). It reduced total cholesterol by 7.4-29.8 mg/dL (8 meta-analyses). The most consistent benefits were shown in studies that used aged garlic extract (AGE). A few small studies that used AGE also showed favorable effects on CAC, CRP, and PWV. Although garlic is generally safe, rare adverse reactions have been documented with limited causality established.

CONCLUSION: We conclude that garlic supplementation has the potential for cardiovascular protection based on risk factor reduction (hypertension and total cholesterol) and surrogate markers (CRP, PWV, and CAC) of atherosclerosis. Larger studies are warranted to evaluate these effects further.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Garlic+crp

Dietary Guidelines for Breast Cancer Patients: A Critical Review

Current dietary guidelines for breast cancer patients (BCPs) fail to address adequate dietary intakes of macro- and micronutrients that may improve patients' nutritional status. This review includes information from the PubMed and Biomed Central databases over the last 15 y concerning dietary guidelines for BCPs and the potential impact of a personalized, nutrient-specific diet on patients' nutritional status during and after antineoplastic treatment. Results indicated that BCPs should receive a nutritional assessment immediately after diagnosis. In addition, they should be encouraged to pursue and maintain a healthy body weight [body mass index (BMI; in kg/m2) 20-24.9], preserving their lean mass and avoiding an increase in fat mass. Therefore, after nutritional status diagnosis, a conservative energy restriction of 500-1000 kcal/d could be considered in the dietary intervention when appropriate. Based on the reviewed information, we propose a personalized nutrition intervention for BCPs during and after antineoplastic treatment. Specifications in the nutritional therapy should be based on the patients' nutritional status, dietary habits, schedule, activities, and cultural preferences. BCPs' daily energy intake should be distributed as follows: <30% fat/d (mainly monounsaturated and polyunsaturated fatty acids), ∼55% carbohydrates (primarily whole foods such as oats, brown rice, and fruits), and 1.2-1.5 g protein ⋅ kg-1 ⋅ d-1 to avoid sarcopenic obesity. Findings suggest that 5-9 servings/d of fruits (∼150 g/serving) and vegetables (∼75 g/serving) should be encouraged. Garlic and cruciferous vegetables must also be part of the nutrition therapy. Adequate dietary intakes of food-based macro- and micronutrients rich in β-carotene and vitamins A, E, and C can both prevent deterioration in BCPs' nutritional status and improve their overall health and prognosis.

https://www.ncbi.nlm.nih.gov/pubmed/28710147

Sulforaphane and neuroinflammmation

Autism spectrum disorder (ASD), characterized by both impaired communication and social interaction, and by stereotypic behavior, affects about 1 in 68, predominantly males. The medico-economic burdens of ASD are enormous, and no recognized treatment targets the core features of ASD. In a placebo-controlled, double-blind, randomized trial, young men (aged 13-27) with moderate to severe ASD received the phytochemical sulforaphane (n = 29)--derived from broccoli sprout extracts--or indistinguishable placebo (n = 15). The effects on behavior of daily oral doses of sulforaphane (50-150 µmol) for 18 wk, followed by 4 wk without treatment, were quantified by three widely accepted behavioral measures completed by parents/caregivers and physicians: the Aberrant Behavior Checklist (ABC), Social Responsiveness Scale (SRS), and Clinical Global Impression Improvement Scale (CGI-I). Initial scores for ABC and SRS were closely matched for participants assigned to placebo and sulforaphane. After 18 wk, participants receiving placebo experienced minimal change (<3.3%), whereas those receiving sulforaphane showed substantial declines (improvement of behavior): 34% for ABC (P < 0.001, comparing treatments) and 17% for SRS scores (P = 0.017). On CGI-I, a significantly greater number of participants receiving sulforaphane had improvement in social interaction, abnormal behavior, and verbal communication (P = 0.015-0.007). Upon discontinuation of sulforaphane, total scores on all scales rose toward pretreatment levels. Dietary sulforaphane, of recognized low toxicity, was selected for its capacity to reverse abnormalities that have been associated with ASD, including oxidative stress and lower antioxidant capacity, depressed glutathione synthesis, reduced mitochondrial function and oxidative phosphorylation, increased lipid peroxidation, and neuroinflammmation.


https://www.ncbi.nlm.nih.gov/pubmed/25313065

Thursday, September 21, 2017

The neurological significance of abnormal natural killer cell activity in chronic toxigenic mold exposures. - PubMed - NCBI

Toxigenic mold activities produce metabolites that are either broad-spectrum antibiotics or mycotoxins that are cytotoxic. Indoor environmental exposure to these toxigenic molds leads to adverse health conditions with the main outcome measure of frequent neuroimmunologic and behavioral consequences. One of the immune system disorders found in patients presenting with toxigenic mold exposure is an abnormal natural killer cell activity. This paper presents an overview of the neurological significance of abnormal natural killer cell (NKC) activity in chronic toxigenic mold exposure. A comprehensive review of the literature was carried out to evaluate and assess the conditions under which the immune system could be dysfunctionally interfered with leading to abnormal NKC activity and the involvement of mycotoxins in these processes. The functions, mechanism, the factors that influence NKC activities, and the roles of mycotoxins in NKCs were cited wherever necessary. The major presentations are headache, general debilitating pains, nose bleeding, fevers with body temperatures up to 40 degrees C (104 degrees F), cough, memory loss, depression, mood swings, sleep disturbances, anxiety, chronic fatigue, vertigo/dizziness, and in some cases, seizures. Although sleep is commonly considered a restorative process that is important for the proper functioning of the immune system, it could be disturbed by mycotoxins. Most likely, mycotoxins exert some rigorous effects on the circadian rhythmic processes resulting in sleep deprivation to which an acute and transient increase in NKC activity is observed. Depression, psychological stress, tissue injuries, malignancies, carcinogenesis, chronic fatigue syndrome, and experimental allergic encephalomyelitis could be induced at very low physiological concentrations by mycotoxin-induced NKC activity. 

https://www.ncbi.nlm.nih.gov/pubmed/14625399

Clinical Diagnosis of the Dampness and Mold Hypersensitivity Syndrome: Review of the Literature and Suggested Diagnostic Criteria. - PubMed - NCBI

A great variety of non-specific symptoms may occur in patients living or working in moisture-damaged buildings. In the beginning, these symptoms are usually reversible, mild, and present irritation of mucosa and increased morbidity due to respiratory tract infections and asthma-like symptoms. Later, the disease may become chronic and a patient is referred to a doctor where the assessment of dampness and mold hypersensitivity syndrome (DMHS) often presents diagnostic challenges. Currently, unanimously accepted laboratory tests are not yet available. Therefore, the diagnosis of DMHS is clinical and is based on the patient's history and careful examination. In this publication, I reviewed contemporary knowledge on clinical presentations, laboratory methods, and clinical assessment of DMHS. From the literature, I have not found any proposed diagnostic clinical criteria. Therefore, I propose five clinical criteria to diagnose DMHS: (1) the history of mold exposure in water-damaged buildings, (2) increased morbidity to due infections, (3) sick building syndrome, (4) multiple chemical sensitivity, and (5) enhanced scent sensitivity. If all the five criteria are met, the patient has a very probable DMHS. To resolve the current problems in assigning correct DMHS diagnosis, we also need novel assays to estimate potential risks of developing DMHS.

https://www.ncbi.nlm.nih.gov/pubmed/28848553

Non-Thyroidal Illness Syndrome in Patients Exposed to Indoor Air Dampness Microbiota Treated Successfully with Triiodothyronine. - PubMed - NCBI

Long-term exposure to dampness microbiota induces multi-organ morbidity. One of the symptoms related to this disorder is non-thyroidal illness syndrome (NTIS). A retrospective study was carried out in nine patients with a history of mold exposure, experiencing chronic fatigue, cognitive disorder, and different kinds of hypothyroid symptoms despite provision of levothyroxine (3,5,3',5'-tetraiodothyronine, LT4) monotherapy. Exposure to volatile organic compounds present in water-damaged buildings including metabolic products of toxigenic fungi and mold-derived inflammatory agents can lead to a deficiency or imbalance of many hormones, such as active T3 hormone. Since the 1970s, the synthetic prohormone, levothyroxine (LT4), has been the most commonly prescribed thyroid hormone in replacement monotherapy. It has been presumed that the peripheral conversion of T4 (3,5,3',5'-tetraiodothyronine) into T3 (3,5,3'-triiodothyronine) is sufficient to satisfy the overall tissue requirements. However, evidence is presented that this not the case for all patients, especially those exposed to indoor air molds. This retrospective study describes the successful treatment of nine patients in whom NTIS was treated with T3-based thyroid hormone. The treatment was based on careful interview, clinical monitoring, and laboratory analysis of serum free T3 (FT3), reverse T3 (rT3) and thyroid-stimulating hormone, free T4, cortisol, and dehydroepiandrosterone (DHEA) values. The ratio of FT3/rT3 was calculated. In addition, some patients received adrenal support with hydrocortisone and DHEA. All patients received nutritional supplementation and dietary instructions. During the therapy, all nine patients reported improvements in all of the symptom groups. Those who had residual symptoms during T3-based therapy remained exposed to indoor air molds in their work places. Four patients were unable to work and had been on disability leave for a long time during LT4 monotherapy. However, during the T3-based and supportive therapy, all patients returned to work in so-called "healthy" buildings. The importance of avoiding mycotoxin exposure via the diet is underlined as DIO2 genetic polymorphism and dysfunction of DIO2 play an important role in the development of symptoms that can be treated successfully with T3 therapy.


https://www.ncbi.nlm.nih.gov/pubmed/28824644

New Rules Required to Curb Childhood Obesity

 Three inexpensive programs have proven to be the most cost-effective ways to reduce childhood obesity rates, results from the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) show.

The work has provided clear evidence that the interventions save more than they cost to implement, said investigator Steven Gortmaker, PhD, from the Harvard T.H. Chan School of Public Health in Boston.

"That's extraordinary," he said here at the American Academy of Pediatrics 2017 National Conference and Exhibition. "These are actual cost-saving interventions."

Dr Gortmaker and his colleagues assessed more than 40 programs on the national agenda by examining evidence reviews from some 130,000 peer-reviewed publications. The team used big data and microsimulation models to project the impact of interventions and their cost-effectiveness over the decade from 2015 to 2025, taking into account trends across states and populations.

The first intervention is the imposition of an excise tax — $0.01 per ounce — on sugar-sweetened beverages. This has been shown to reduce consumption and is inexpensive to implement because tax systems are already in place. Projected savings of about $14 billion come from the slower rise in obesity rates induced by the tax, and do not include the expected $12.5 billion increase in national tax revenue.


http://www.medscape.com/viewarticle/885984

Dietary Supplement With Ketones May Mitigate Migraine Attacks

"We know that ketone bodies are not only metabolized, they're also signaling molecules. First of all, they're a more efficient fuel than glucose. Per molecule, they produce a lot more ATP [adenosine triphosphate] than a molecule of glucose," she said. "They also induce mitochondrial biogenesis, [and] they're very potent reactive oxygen species inhibitors.

Further, they produce less oxidative stress per molecule burned and reduce brain excitability, she added. "They shift the equilibrium between glutamate and GABA [γ-aminobutyric acid] in the direction of GABA, and they also have an influence on glutamate transport itself."

She went on to note that supplying more KBs increases ketone body transporter mechanisms, they are anti-inflammatory, and they reduce blood glucose levels. "So they have a variety of potential migraine-relevant mechanisms in addition to being a more effective fuel" than glucose.

She and her colleagues have started enrolling patients with migraine in a double-blind, randomized, placebo-controlled trial (NCT03132233) to test the bHB supplement in a crossover design over 3 months in a group of 90 participants.

The impetus for this work was the fact that Gross developed migraines in her mid-teens, and she said she wants something that will work for her and for many other patients with migraine. The side effects of currently approved prophylactic drugs are "intolerable for most patients," she said, and avoiding food and lifestyle triggers of migraines severely limits ones activities and life.

http://www.medscape.com/viewarticle/886000

Sunday, September 17, 2017

Nickel allergy: How to avoid exposure and reduce symptoms | American Academy of Dermatology

Avoid foods containing nickel if you are extremely sensitive to nickel. Some foods that contain high amounts of nickel include soy products—such as soybeans, soy sauce, and tofu—licorice, buckwheat, cocoa powder, clams, cashews, and figs.

https://www.aad.org/public/diseases/rashes/nickel-allergy

Frame Materials and Metal Allergies

The most common cause of metal allergies is mercury, and this is followed by metals including nickel, cobalt, tin, palladium and chrome.Conversely, metals such as gold, titanium, silver and iron are less likely to produce allergic reactions since they rarely dissolve upon contact with perspiration or other bodily fluids.

Of the metals most likely to produce allergic reactions, nickel is the one that is most commonly used in spectacle frames. For a long time, nickel has been used in the form of an alloy as a material for spectacle frames and is also used as the base plating material for plating and gold plating, for example. 

Compared with other metals, the properties of nickel make it readily dissolvable, and this means that contact of the body with nickel will result in the metal beginning to dissolve due to the effect of sodium ions in perspiration, causing an allergic reaction.

However, as a recent measure to prevent allergic reactions, the materials used in many products on the market nowadays are nickel-free. In addition, frames with vinyl-covered temples are now available for people with metal allergies.

People who may have metal allergies are recommended to undergo a patch test at a dermatologist. Forearmed with knowledge of which metals are likely to cause an allergic reaction, you will know which metals to avoid when purchasing spectacles.

http://seikoeyewear.com/eye-information/about-frames/materials-metal-allegries

Nickel Allergies on Rise as Devices Meet Skin - NYTimes.com

Nickel, one of the most common allergens in the United States, can be found in things like hand-held devices and jewelry. But unlike Europe, the United States has no restrictions on its widespread use in consumer products. That worries some doctors who say that the growing use of mobile and hand-held devices combined with a lack of regulatory oversight could lead to a spike in allergic reactions.

"I am absolutely concerned about it," said Stephen P. Stone, the director of clinical research in dermatology at the Southern Illinois University School of Medicine and the former president of the American Academy of Dermatology.

The Centers for Disease Control and Prevention estimates that 10 to 20 percent of the population is allergic to nickel. The reactions can be unpleasant, but not fatal. Typically they include blistering, redness and dry skin.



https://mobile.nytimes.com/2014/08/21/technology/personaltech/nickel-allergies-on-rise-as-devices-meet-skin.html?referer=https://duckduckgo.com/

Wednesday, September 13, 2017

Fire Retardants Found in Furniture and Gym Mats Implicated in Infertility

PFRs are commonly added to polyurethane foam, gym mats and baby items such as car seats, ostensibly to reduce the risk of the items catching fire. However, the chemicals do not remain in these items. They spread, contaminating air and dust. They can also migrate through direct contact. One 2015 study13 found nearly every dust sample collected from American homes contained the flame retardants Tris phosphate and triphenyl phosphate (TPHP).

Ninety-one percent of urine samples from the residents also contained metabolites of Tris phosphate, and 83 percent had metabolites of TPHP. Disturbingly, toddlers have been found to have levels of flame retardants that are as much as five times higher than their mother's.14 Needless to say, bioaccumulation can have serious health consequences over the course of a lifetime, and may ultimately affect the reproductive capacity of coming generations.


http://fitness.mercola.com/sites/fitness/archive/2017/09/08/flame-retardants-health-effects.aspx

Tuesday, September 12, 2017

Exposure to Disinfectants Linked to COPD

This was a "well-performed study," said Lidwien Smit, PhD, from the University of Utrecht in the Netherlands. "I just wonder about the pathology, and how it influences the microbiome."

"Disinfectants are meant to kill off bacteria, but if you're exposed to large concentrations, you're also inhaling them, which could affect your airway microbes," she explained.

In fact, disinfectants could play a role in killing off bacterial communities in the airways that are responsible for "immune homeostasis" and keep users healthy, she added.

If that immune balance gets disturbed, it might have an influence on a person's reaction to pathogens or inflammation. "This is all part of the COPD pathology — that could be another interesting hypothesis to study," Dr Smit told Medscape Medical News.

Dr Dumas is clear that this is preliminary observational research and more studies are needed. Determining which agents are most harmful "would help define guidelines to protect workers," she noted.

The current findings do not show that the disinfectants are a direct cause of COPD, but they do draw an association between some disinfectants and development of the disease. "I hope this study will help open the discussion for better guidelines," Dr Dumas said.

http://www.medscape.com/viewarticle/885575

Saturday, September 2, 2017

The Unexpected and Troubling Rise of Candida auris

Hello. I am Dr Tom Chiller, chief of the Mycotic Diseases Branch at the Centers for Disease Control and Prevention (CDC). As part of the CDC Expert Commentary Series on Medscape, I would like to tell you about Candida auris, a novel yeast that is behaving in unexpected and concerning ways, causing severe disease in countries across the globe, including the United States. Today we'll share how you can protect your patients from this potentially deadly infection, the history of this unusual bug, and how the United States is working with global partners to combat its spread.


http://www.medscape.com/viewarticle/884470

Monday, August 28, 2017

Dark Hair Dye and Chemical Relaxers Linked to Breast Cancer



The study of 4,285 African-American and white women was the first to find a significant increase in breast cancer risk among black women who used dark shades of hair dye and white women who used chemical relaxers.

Black women who reported using dark hair dye had a 51 percent increased risk of breast cancer compared to black women who did not, while white women who reported using chemical relaxers had a 74 percent increased risk of breast cancer, the study found.

The risk of breast cancer was even higher for white women who regularly dyed their hair dark shades and also used chemical relaxers, and it more than doubled for white dual users compared to white women who used neither dark dye nor chemical straighteners.

The association between relaxers and breast cancer in white women surprised lead author Adana Llanos, an epidemiologist at the Rutgers School of Public Health in Piscataway, New Jersey, although she worried enough about the safety of hair relaxers in African-American women like herself to stop using them years ago.

http://www.medscape.com/viewarticle/882833

Sunday, August 27, 2017

HLA-DQ:gluten tetramer test in blood gives better detection of coeliac patients than biopsy after 14-day gluten challenge

A 14-day gluten challenge was not enough to establish significant mucosal architectural changes in majority of patients with coeliac disease (sensitivity ≈25%–50%). Increase in CD4+ effector-memory gut-homing HLA-DQ:gluten tetramer-binding T cells in blood 6 days after gluten challenge is a more sensitive and less invasive biomarker that should be validated in a larger study.

http://gut.bmj.com/content/early/2017/08/04/gutjnl-2017-314461

HPHPA and Clostridia


The dysbiosis marker 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA), the predominant dihydroxyphenylpropionic acid isomer in urine, is also measured in the Organic Acids Test offered by The Great Plains Laboratory. This marker was proven by Dr. William Shaw to be due to a combination of human metabolism and the metabolism by a group of Clostridia species, including but not limited to C. difficile.

HPHPA has been one of the most useful clinical markers in recent medical history. Treatment with metronidazole, vancomycin, or high doses of probiotics of individuals with high urinary values has led to significant clinical improvements or remissions of psychosis.

The biochemical role of Clostridia in altering brain neurotransmitters is due to the fact that Clostridia metabolites inactivate dopamine beta-hydroxylase, leading to an excess production of brain dopamine and reduced levels of the neurotransmitter norepinephrine. Excess dopamine is associated with abnormal or psychotic behavior. This imbalance can be demonstrated in the Organic Acids Urine Test by observing the ratio of the major dopamine metabolite, homovanillic acid (HVA), to that of the major norepinephrine metabolite, vanillylmandelic acid (VMA) when the Clostridia marker HPHPA is elevated. After treatment with metronidazole or vancomycin, HPHPA values return to normal along with normal ratios of HVA/VMA and normal behavior.

The highest value of HPHPA was measured in the urine of a young woman with first onset of schizophrenia. Treatment of Clostridia bacteria resulted in loss of auditory hallucinations. In autism, children with gastrointestinal Clostridia commonly exhibit aggressive behavior, agitation, obsessive compulsive behavior, and irritability. They may have very foul stools with diarrhea with mucus in the stools although some individuals may be constipated. Stool testing for Clostridia is usually of limited usefulness since most Clostridia species are considered probiotics or beneficial. There are about 100 species of Clostridia that are commonly found in the gastrointestinal tract. Only seven of these species are producers of HPHPA including C. sporogenes, C.botulinum, C. caloritolerans, C. angenoti, C. ghoni, C.bifermentans, C. difficile, and C. sordellii while C. tetani,C. sticklandii, C. lituseburense, C. subterminale, C.putifaciens, C. propionicum, C. malenomenatum, C.limosum, C. lentoputrescens, C. tetanomorphum, C.coclearium, C. histolyticum, C. aminovalericum, and C.sporospheroides do not produce compounds that are converted to HPHPA.

The same article by Dr. Shaw indicates that 3,4-dihydroxyphenylpropionic acid (DHPPA) is a marker for beneficial bacteria in the gastrointestinal tract such as Lactobacilli, Bifidobacteria, and E. coli. The exception is one species of Clostridia orbiscindens that can convert the flavanoids luteolin and eriodictyol, that occur only in a relatively small food group that includes parsley, thyme, celery, and sweet red pepper to 3,4-dihydroxyphenylpropionic acid. The quantity of C. orbiscindens in the gastrointestinal tract is negligible (approximately 0.1% of the total bacteria) compared to the predominant flora of Lactobacilli, Bifidobacteria, and E. coli (7). DHPPA is an antioxidant that lowers cholesterol, reduces proinflammatory cytokines, and protects against pathogenic bacteria. 2,3-Dihydroxyphenypropionic acid, a different isomer has been claimed to be a metabolite of Pseudomonas species but the literature indicates that this compound is formed by the in vitro action of these species on quinoline, a component of coal tar, a substance missing from the diet of virtually all humans. 

http://integrativemedicineformentalhealth.com/articles/shaw_hphpa.html

Saturday, August 26, 2017

More Young People Are Dying of Colon Cancer - NYTimes.com

While rates of cancers tied to human papillomavirus, or HPV, have been rising in recent years, that virus causes cancers mainly of the cervix, back of the throat and anus, and scientists do not believe sexual behaviors or HPV are driving the increase in colon or rectal cancer (anal and rectal cancers are distinct).

Obesity, a diet high in red or processed meats and lack of physical activity are among the factors tied to increased risk, but new research is looking at other possible causes. One recent study found, for example, that prolonged use of antibiotics during adulthood was associated with a greater risk of developing precancerous polyps, possibly because antibiotics can alter the makeup of the gut microbiome.

https://mobile.nytimes.com/2017/08/22/well/live/more-young-people-are-dying-of-colon-cancer.html

Toxic metal hip replacements could cause Alzheimer's | Daily Mail Online

Doctors are being urged to check for signs of dementia or heart disease in hip implant patients.

There are concerns that the metal-on-metal devices are leaching toxic chemicals into the blood which cause serious health complications.

The Medicines and Healthcare products Regulatory Agency announced last month that patients would be called in for x-rays and blood tests to check for adverse reactions.

Now a spokesman for the watchdog said it was also keeping a 'weather eye' on a possible link to heart attacks and dementia.

Dr Neil McGuire, clinical director of medical devices at the MHRA, said he wanted to establish whether cobalt leached from the implants was causing adverse effects.
Patients with the 'metal on metal' hip implants will be advised to have X-rays and undergo blood tests due to fears of their toxicity

http://www.dailymail.co.uk/health/article-4682268/Fresh-warning-toxic-metal-hip-replacements.html

Saturday, August 19, 2017

Why You’re Not Losing Weight On Your Diet | Time.com

Another area that has some scientists excited is the question of how weight gain is linked to chemicals we are exposed to every day--things like the bisphenol A (BPA) found in linings of canned-food containers and cash-register receipts, the flame retardants in sofas and mattresses, the pesticide residues on our food and the phthalates found in plastics and cosmetics. What these chemicals have in common is their ability to mimic human hormones, and some scientists worry they may be wreaking havoc on the delicate endocrine system, driving fat storage.

"The old paradigm was that poor diet and lack of exercise are underpinning obesity, but now we understand that chemical exposures are an important third factor in the origin of the obesity epidemic," says Dr. Leonardo Trasande, an associate professor of pediatrics, environmental medicine and population health at New York University's School of Medicine. "Chemicals can disrupt hormones and metabolism, which can contribute to disease and disability."

Another frontier scientists are exploring is how the microbiome--the trillions of bacteria that live inside and on the surface of the human body--may be influencing how the body metabolizes certain foods. Dr. Eran Elinav and Eran Segal, researchers for the Personalized Nutrition Project at the Weizmann Institute of Science in Israel, believe the variation in diet success may lie in the way people's microbiomes react to different foods.

http://time.com/4793832/the-weight-loss-trap/

Wednesday, August 16, 2017

Japanese fungus spreading in UK hospitals - BBC News

What is Candida auris?

It belongs to a family of fungi or yeasts that live on the skin and inside the human body.

A more common "cousin" in this family is Candida albicans, which causes the yeast infection thrush.

Candida auris was first identified in 2009 in a patient from Japan.

Hospital outbreaks have since been reported in the United States, India, Pakistan, Venezuela, Colombia, Israel, Oman, South Africa and Spain, as well as the UK.


http://www.bbc.com/news/health-40934190

Wednesday, August 9, 2017

Medicare to cover supervised exercise for heart disease

Following a request from cardiologists, the CMS will now offer national Medicare coverage of supervised exercise therapy for treating peripheral artery disease

The agency said in a coverage decision released Thursday that research has shown supervised exercise therapy can help alleviate common symptoms of the cardiovascular disease, including pain and discomfort in a patient's legs.

Peripheral artery disease occurs when plaque buildup narrows the arteries outside the heart. It affects 12% to 20% of Americans age 60 and older, and the incidence of the disease increases considerably with age.

Without exercise, individuals with peripheral artery disease could see their condition worsen to the point they lose functional independence.

"Medicare beneficiaries, a significant portion of which have peripheral artery disease will benefit considerably from participating in supervised exercise therapy sessions," American Heart Association CEO Nancy Brown said in a statement. "Evidence shows this therapy can improve quality of life for patients and enhance clinical outcomes."

Supervised exercise is a non-invasive treatment option, which can alleviate leg pain during exercise and improve a patient's walking distance, according to the American Heart Association.



http://www.modernhealthcare.com/article/20170530/NEWS/170539995

Monday, August 7, 2017

Take the Generic, Patients Are Told. Until They Are Not. - NYTimes.com

Consumers have grown accustomed to being told by insurers — and middlemen known as pharmacy benefit managers — that they must give up their brand-name drugs in favor of cheaper generics. But some are finding the opposite is true, as pharmaceutical companies squeeze the last profits from products that are facing cheaper generic competition.

Out of public view, corporations are cutting deals that give consumers little choice but to buy brand-name drugs — and sometimes pay more at the pharmacy counter than they would for generics.

The practice is not easy to track, and has been going on sporadically for years. But several clues suggest it is becoming more common.


https://mobile.nytimes.com/2017/08/06/health/prescription-drugs-brand-name-generic.html

Sunday, August 6, 2017

Exercise Top Lifestyle Factor for Alzheimer's Prevention?

 A growing body of research suggests that physical activity not only improves executive function and cerebral blood flow but may also reduce amyloid and tau levels in the brain.

The new findings were presented here at Alzheimer's Association International Conference (AAIC) 2017.

Much of the focus of this year's AAIC meeting was on lifestyle interventions – healthy eating, reduced stress, adequate sleep, and increased physical activity – to help prevent dementia. Some experts believe that of all lifestyle factors, exercise is tops when it comes to preserving cognition.

In recent years, the identification of biomarkers for Alzheimer's disease (AD) has made it possible to compare levels of amyloid-beta (Aβ) and tau ― both hallmarks of AD ― in those who are and those who are not physically active.

One new study presented here, led by Belinda M. Brown, PhD, School of Psychology and Exercise Science, Murdoch University, Perth, Australia, evaluated the relationship between exercise levels and brain amyloid load in carriers of genetic mutations that cause autosomal-dominant AD.

The analysis included data from the Dominantly Inherited Alzheimer Network for 139 presymptomatic mutation carriers. These patients are destined to develop AD and know approximately when they will start having symptoms.

From self-reports of exercise, the researchers categorized patients into those reporting fewer than 150 minutes per week of (low exercise) and those reporting 150 minutes or more per week (high exercise).

The researchers also had information on brain amyloid load, as quantified by Pittsburgh compound B positron-emission tomography (PiB PET). They stratified patients in order to investigate those with high brain amyloid levels (PiB+).

Compared to the high-exercise group, the low-exercise group was older (38.6 years vs 33.7 years) and had more depressive symptoms, as measured by the Geriatric Depression Scale (2.2 vs 1.4).

http://www.medscape.com/viewarticle/883781

Friday, August 4, 2017

Drinking Milk Is Linked to Parkinson’s Disease: Study | Time.com

Abbott and his team studied 449 brains and recorded the density of neurons in specific areas of the brain known to be affected by Parkinson's. They found that men who reported drinking more than two glasses of milk a day (16 oz) showed the thinnest nerve networks in these areas, suggesting compromised function of these nerves, compared to men who drank little or no milk. The milk drinkers also had residues of specific organochlorines called heptachlor epoxide.

Interestingly, by measuring when cells in motor nerve regions died, they also learned that the accumulation of heptachlor epoxide occurred before the cells were damaged, strongly hinting that the chemical was responsible for triggering the changes associated with Parkinson's.


http://time.com/4143358/milk-parkinsons-disease-pesticides/

Thursday, August 3, 2017

How Overeating May Contribute to a Metabolic "Traffic Jam" - Scientific American Blog Network

Around 15 years ago, the lab of David Kelley, MD, then at the University of Pittsburgh, had a hunch that what really matters for metabolic health might be the cell's ability to select the right fuel for the right physiological setting (i.e. fasting or feeding, exercise or not). They found that in individuals who where obese or had type II diabetes, their mitochondria had lost the capacity to make this decision. In other words, mitochondria were unable to efficiently direct traffic. This is known as metabolic inflexibility and it has been linked with numerous ailments such as obesity, heart disease, and disorders of the liver and ovaries.

https://blogs.scientificamerican.com/guest-blog/how-overeating-may-contribute-to-a-metabolic-traffic-jam/

Boosting Brain Ketone Metabolism: A New Approach to Alzheimer's


"The ketogenic diet has been used in epilepsy for almost 100 years and has been shown to reduce intractable seizures," Russell H. Swerdlow, MD, University of Kansas Alzheimer's Disease Center, Fairway, who presented the ketogenic diet study, told Medscape Medical News.

"Our results suggest it could also be useful in other forms of neurological disease like Alzheimer's, but it is not an easy diet to follow," he added. "The point of our study is that it helps to establish a principle that brain metabolism can be rescued by a fuel other than glucose."

Dr Cunnane noted that studies have shown glucose uptake into the brain frontal cortex to be 14% lower in cognitively healthy older people than in younger healthy people. Patients with early Alzheimer's have a greater deficit, with 20% to 30% less glucose uptake than cognitively normal older people.

"Anybody trying to function with 20% less brain glucose long term will suffer from brain exhaustion," he said. 

http://www.medscape.com/viewarticle/883743

Depression in CAD Trumps All Other Risk Factors for Death

Depression and coronary artery disease are known to walk hand in hand, but a new study suggests that depression any time after a diagnosis of CAD is the strongest predictor of death[1].

Among 24,137 patients identified with significant CAD, a new depression diagnosis was associated with a twofold higher risk of all-cause death after multivariable adjustment, the investigators reported in the European Heart Journal Quality of Care and Clinical Outcomes.

"It was stronger than any follow-up events, stronger than diabetes, stronger than smoking, sex, prior diagnosis of high blood pressure or depression, and even whether they had a heart attack," lead author Dr Heidi T May (Intermountain Heart Institute, Murray, UT) told theheart.org | Medscape Cardiology. "I thought it would be a significant predictor, but I didn't anticipate it would be the strongest.

"I would think most people would find that amazing."


http://www.medscape.com/viewarticle/883751

The Myth of Drug Expiration Dates - ProPublica

The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless.

But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

Cantrell called Roy Gerona, a University of California, San Francisco, researcher who specializes in analyzing chemicals. Gerona had grown up in the Philippines and had seen people recover from sickness by taking expired drugs with no apparent ill effects.

"This was very cool," Gerona says. "Who gets the chance of analyzing drugs that have been in storage for more than 30 years?"

https://www.propublica.org/article/the-myth-of-drug-expiration-dates

Sunday, July 30, 2017

Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis



This review explores the current evidence on benefits and harms of therapeutic interventions in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and makes recommendations. CFS/ME is a complex, multi-system, chronic medical condition whose pathophysiology remains unknown. No established diagnostic tests exist nor are any FDA-approved drugs available for treatment. Because of the range of symptoms of CFS/ME, treatment approaches vary widely. Studies undertaken have heterogeneous designs and are limited by sample size, length of follow-up, applicability and methodological quality. The use of rintatolimod and rituximab as well as counselling, behavioural and rehabilitation therapy programs may be of benefit for CFS/ME, but the evidence of their effectiveness is still limited. Similarly, adaptive pacing appears to offer some benefits, but the results are debatable: so is the use of nutritional supplements, which may be of value to CFS/ME patients with biochemically proven deficiencies. To summarize, the recommended treatment strategies should include proper administration of nutritional supplements in CFS/ME patients with demonstrated deficiencies and personalized pacing programs to relieve symptoms and improve performance of daily activities, but a larger randomized controlled trial (RCT) evaluation is required to confirm these preliminary observations. At present, no firm conclusions can be drawn because the few RCTs undertaken to date have been small-scale, with a high risk of bias, and have used different case definitions. Further, RCTs are now urgently needed with rigorous experimental designs and appropriate data analysis, focusing particularly on the comparison of outcomes measures according to clinical presentation, patient characteristics, case criteria and degree of disability (i.e. severely ill ME cases or bedridden).

https://www.ncbi.nlm.nih.gov/pubmed/28052319

The autoimmune/inflammatory syndrome induced by adjuvants (ASIA)/Shoenfeld’s syndrome


The autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is a recently identified condition in which the exposure to an adjuvant leads to an aberrant autoimmune response. We aimed to summarize the results obtained from the ASIA syndrome registry up to December 2016, in a descriptive analysis of 300 cases of ASIA syndrome, with a focus on the adjuvants, the clinical manifestations, and the relationship with other autoimmune diseases. A Web-based registry, based on a multicenter international study, collected clinical and laboratory data in a form of a questionnaire applied to patients with ASIA syndrome. Experts in the disease validated all cases independently. A comparison study regarding type of adjuvants and differences in clinical and laboratory findings was performed. Three hundred patients were analyzed. The mean age at disease onset was 37 years, and the mean duration of time latency between adjuvant stimuli and development of autoimmune conditions was 16.8 months, ranging between 3 days to 5 years. Arthralgia, myalgia, and chronic fatigue were the most frequently reported symptoms. Eighty-nine percent of patients were also diagnosed with another defined rheumatic/autoimmune condition. The most frequent autoimmune disease related to ASIA syndrome was undifferentiated connective tissue disease (UCTD). ASIA syndrome is associated with a high incidence of UCTD and positive anti-nuclear antibodies (ANA) test. Clinical and laboratory features differ from the type of adjuvant used. These findings may contribute to an increased awareness of ASIA syndrome and help physicians to identify patients at a greater risk of autoimmune diseases following the exposure to vaccines and other adjuvants. The ASIA syndrome registry provides a useful tool to systematize this rare condition.

https://www.ncbi.nlm.nih.gov/pubmed/28741088

https://link.springer.com/article/10.1007%2Fs10067-017-3748-9

Antibody wipeout found to relieve chronic fatigue syndrome

"I was completely revitalised," says Karen. "Suddenly, I could be sociable again. I would go to work, go home, eat dinner and feel restless."

Karen (not her real name) experienced this relief from chronic fatigue syndrome while taking a drug that is usually used to treat the blood cancer lymphoma and rheumatoid arthritis (see "Karen's experience", below).

She was one of 18 people with CFS who reported improvements after taking rituximab as part of a small trial in Bergen, Norway. The results could lead to new treatments for the condition, which can leave people exhausted and housebound.

Finding a cause for CFS has been difficult. Four years ago, claims that a mouse virus was to blame proved to be unfounded, and some have suggested the disease is psychosomatic.

The latest study implicates the immune system, at least in some cases. Rituximab wipes out most of the body's B-cells, which are the white blood cells that make antibodies.

Øystein Fluge and Olav Mella of the Haukeland University Hospital in Bergen noticed its effect on CFS symptoms in 2004, when they used the drug to treat lymphoma in a person who happened to also have CFS.

Several months later, the person's CFS symptoms had disappeared. A small, one-year trial in 2011 found that two-thirds of those who received rituximab experienced relief, compared with none of the control group.

The latest study, involving 29 people with CFS, shows that repeated rituximab infusions can keep symptoms at bay for years.

"Eleven of the 18 responders were still in remission three years after beginning the treatment, and some have now had no symptoms for five years," says Fluge. "Suddenly, their limbs started to work again and their hands were no longer cold or sweaty."

"I am very intrigued by the rituximab story," says Nancy Klimas, an authority on CFS at Nova Southeastern University in Fort Lauderdale, Florida. "It's particularly exciting when people seem to have experienced very long periods of remission, and even speak of recovery," she says.

https://www.newscientist.com/article/dn27813-antibody-wipeout-found-to-relieve-chronic-fatigue-syndrome/

EWG Tap Water Database

On Wednesday, EWG released its groundbreaking National Tap Water Database – a project two years in the making that allows nearly every American to punch in their zipcode to find out exactly what's in their local drinking water and how it can affect their health. The information in the database goes far beyond anything utilities or the Environmental Protection Agency provides. EWG found a number of contaminants, that while regulated under the Safe Drinking Water Act, are often found at levels that many scientists believe pose health risks.

"Americans deserve the fullest picture possible of what's in their tap water," said EWG President Ken Cook. "But they won't get that information from the government or, in many cases, from their utilities. The only place they'll find that is EWG's drinking water report."

The database provides real solutions to Americans concerned about their water quality. First and foremost, it provides advice on choosing the right water filter so they can take matters into their own hands and remove contaminants. Filtering tap water is not only cheaper than bottled water – it's far better for the environment, too.  


https://www.ewg.org/tapwater/

Sperm count: Fertility in men on the decline due to everyday plastics say scientists

Men are suffering a sharp decline in fertility because of the prevalence of every-day plastics, say scientists.

And Niels Jørgensen, associate professor at Rigshospital, Copenhagen, has told the European Society for Human Reproduction and Embryology's conference in Lisbon that only one in four men have "good" sperm.

According to The Times, phthalates, chemicals that are found in shower curtains, car dashboards and cleaning materials, "can be breathed in, consumed or absorbed through the skin of pregnant women, inhibiting testosterone production in male foetuses, leading to sons with low sperm counts".

Jørgensen said that society should be "very worried" by these studies, and advised women to try to avoid cosmetics.

http://www.ibtimes.co.uk/sperm-count-fertility-men-decline-due-everyday-plastics-say-scientists-1506746

Friday, July 28, 2017

Consuming Walnuts Boost Good Bacteria

Walnut consumption may increase the amount of beneficial bacteria in the gut, according to a recent animal study published in The Journal of Nutritional Biochemistry.

At the end of 10 weeks, rats fed a diet containing ground walnuts showed an increase in beneficial bacteria types including, Lactobacillus, Roseburia, and Ruminococcaceae.

Rats in the walnut diet group also showed greater gut bacteria diversity than those consuming the walnut-free control diet.

"The diet groups had distinct microbial communities with animals consuming walnuts displaying significantly greater species diversity," concluded the researchers from Louisiana State University.

The finding is also important because the ability to positively influence gut bacteria composition with foods like walnuts may eventually lead to better health outcomes.

"Gut health is an emerging research area, but we are seeing that greater bacterial diversity may be associated with better health outcomes, whereas low diversity has been linked to conditions such as obesity and inflammatory bowel disease," said lead researcher professor Lauri Byerley.
'Superfood'

http://mobile.dudasite.com/site/preventdisease/default?url=http%3A%2F%2Fpreventdisease.com%2Fnews%2F17%2F072717_Consuming-Walnuts-Boost-Good-Bacteria.shtml#2767

England’s Mental Health Experiment: No-Cost Talk Therapy - NYTimes.com

LONDON — England is in the midst of a unique national experiment, the world's most ambitious effort to treat depression, anxiety and other common mental illnesses.

The rapidly growing initiative, which has gotten little publicity outside the country, offers virtually open-ended talk therapy free of charge at clinics throughout the country: in remote farming villages, industrial suburbs, isolated immigrant communities and high-end enclaves. The goal is to eventually create a system of primary care for mental health not just for England but for all of Britain.

At a time when many nations are debating large-scale reforms to mental health care, researchers and policy makers are looking hard at England's experience, sizing up both its popularity and its limitations. Mental health care systems vary widely across the Western world, but none have gone nearly so far to provide open-ended access to talk therapies backed by hard evidence. Experts say the English program is the first broad real-world test of treatments that have been studied mostly in carefully controlled lab conditions.

https://mobile.nytimes.com/2017/07/24/health/england-mental-health-treatment-therapy.html

Wednesday, July 26, 2017

Influenza: marketing vaccine by marketing disease | The BMJ

Promotion of influenza vaccines is one of the most visible and aggressive public health policies today. Twenty years ago, in 1990, 32 million doses of influenza vaccine were available in the United States. Today around 135 million doses of influenza vaccine annually enter the US market, with vaccinations administered in drug stores, supermarkets—even some drive-throughs. This enormous growth has not been fueled by popular demand but instead by a public health campaign that delivers a straightforward, who-in-their-right-mind-could-possibly-disagree message: influenza is a serious disease, we are all at risk of complications from influenza, the flu shot is virtually risk free, and vaccination saves lives. Through this lens, the lack of influenza vaccine availability for all 315 million US citizens seems to border on the unethical. Yet across the country, mandatory influenza vaccination policies have cropped up, particularly in healthcare facilities,1 precisely because not everyone wants the vaccination, and compulsion appears the only way to achieve high vaccination rates.2 Closer examination of influenza vaccine policies shows that although proponents employ the rhetoric of science, the studies underlying the policy are often of low quality, and do not substantiate officials' claims. The vaccine might be less beneficial and less safe than has been claimed, and the threat of influenza appears overstated.

http://www.bmj.com/content/346/bmj.f3037

Study points to possible trigger of chronic fatigue symptoms, offering hope of new therapies

A study by University of Florida Health researchers published recently in the Journal of Pain Research provides a possible explanation for that atypical exhaustion, supporting a hypothesis that the bodies of those with chronic fatigue inappropriately magnify minute muscle byproducts caused by exertion.

"People with chronic fatigue are essentially sensing muscle metabolites while they are not doing anything, and they're not supposed to be," said Roland Staud, M.D., a professor of rheumatology and clinical immunology in the UF College of Medicine and the study's lead author. "Generally speaking, when we're at rest, we don't feel our muscles."

http://www.medicalnewstoday.com/releases/318570.php

Sulforaphane reduces hepatic glucose production and improves glucose control in patients with type 2 diabetes

 We therefore investigated the compound with the highest overlap, SFN, in greater detail. SFN is a naturally occurring isothiocyanate found in cruciferous vegetables such as broccoli. It activates nuclear factor erythroid 2–related factor 2 (NRF2) by modifying the conformation of Kelch-like ECH-associated protein 1 (KEAP1) cytoplasmic chaperone, thus releasing NRF2 for translocation to the nucleus and transcriptional activation of genes with the antioxidant response element (ARE) in their promoters (23). Although SFN uptake into cells leads to an initial burst of reactive oxygen species, it then rapidly activates the KEAP1-NRF2-ARE system to induce antioxidant enzymes and increase cellular glutathione for an overall antioxidative effect (24). As an inducer of endogenous antioxidants, SFN has been extensively studied for its protective effects in different experimental models associated with oxidative stress and chemoprotection (25), inflammatory disorders (26), and fatty liver disease (27, 28). To date, SFN has not been implicated for the treatment of exaggerated hepatic glucose production in T2D.


http://stm.sciencemag.org/content/9/394/eaah4477.full

Friday, July 21, 2017

No Reduction in CVD Events With PAP Treatment of Sleep Apnea

The use of positive airway pressure (PAP) to treat sleep apnea does not reduce the risk of cardiovascular events and death, a new analysis suggests[1].

In a meta-analysis of 10 randomized clinical trials comprising more than 7000 patients, PAP was not associated with a reduction in major adverse cardiovascular events (MACE), cardiovascular death, all-cause death, stroke, or heart failure compared with no or sham treatment.

"While sleep apnea is clearly associated in observational studies with risks of cardiovascular disease, it doesn't seem as if those risks can be reversed by treating people with PAP," coauthor Dr Bruce Neal, the George Institute for Global Health, University of New South Wales, Sydney, Australia, said in an interview.

"Whether that's because our treatment method with PAP isn't very good or whether the association that we see in the observational studies is being driven by something else isn't really clear to us," Neal said.

The results were published online July 11, 2017 in JAMA.

http://www.medscape.com/viewarticle/883157

Thursday, July 20, 2017

One Third of Dementia May Be Preventable With Lifestyle Change

More than one third of global dementia cases may be preventable by addressing nine lifestyle factors that affect an individual's risk, according to the findings of a new comprehensive report from The Lancet Commission on Dementia Prevention, Intervention, and Care.

The report, presented today at the Alzheimer's Association International Conference (AAIC) 2017 and simultaneously published in The Lancet, was compiled by 24 international experts in the field of dementia who reviewed the available literature in the field and conducted a new meta-analysis that included some risk factors not considered in previous similar analyses.

They found that nine lifestyle factors are responsible for 35% of dementia burden. These factors include not completing secondary education in early life; hypertension; obesity and hearing loss in midlife; and smoking, depression, physical inactivity, social isolation, and diabetes in later life.


http://www.medscape.com/viewarticle/883211

Monday, July 17, 2017

Heartburn drugs tied to greater mortality

Widely used heartburn drugs are associated with increased risk of death, and the longer a person uses the drugs, the greater the risk, new research suggests.

Proton pump inhibitors or PPIs, have been tied to a wide range of side effects including fractures, dementia, heart disease, pneumonia and kidney disease, the study's senior author Dr. Ziyad Al-Aly of Washington University School of Medicine in St. Louis told Reuters Health in a telephone interview.

"We took it a bit further and asked is this class associated with a higher risk of death, and the answer is yes," he said.

. http://www.foxnews.com/health/2017/07/05/heartburn-drugs-tied-to-greater-mortality.html

Inflammatory Dietary Pattern Linked to Brain Aging

Researchers believe they have uncovered a key piece of the puzzle in the connection between diet and dementia.

They linked a specific dietary pattern to blood markers of inflammation. In addition, they showed that in elderly adults who followed such a dietary pattern, brain gray matter volume was less, and they had worse visuospatial cognitive function.

"We found that people who consume less omega 3, less calcium, vitamin E, vitamin D, and vitamin B5 and B2 have more inflammatory biomarkers," study investigator Yian Gu, PhD, Columbia University and the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York City, told Medscape Medical News.

An inflammatory dietary pattern, said Dr Gu, "is bad for both the brain and cognition."

The study was presented here at the Alzheimer's Association International Conference (AAIC) 2017.

http://www.medscape.com/viewarticle/883038

Saturday, July 15, 2017

Study: Blood Test Detects Pancreatic Cancer

Scientists have identified a pair of markers—readily detectable in patients' blood using an enzyme-linked immunosorbent assay (ELISA)—that can accurately identify those with early-stage pancreatic ductal adenocarcinoma (PDAC), according to a report published yesterday in Science (July 12).

The mortality rate for pancreatic cancer is staggeringly high—a 7 percent 5-year survival rate, according to an estimate from the American Cancer Society—and it's expected to rank second on the list of top causes of cancer death within the next three years, write the authors in their report.

Doctors are typically only able to detect this cancer "after it causes pronounced symptoms, when it has advanced far enough to be lethal," lead author Kenneth Zaret of the Perelman School of Medicine at the University of Pennsylvania tells UPI.

The researchers sought to find markers that could catch patients with the disease before it progressed into later stages. In a prior study, they modeled the advance of this disease by manipulating human PDAC cells into a pluripotent state, hypothesizing that they "might undergo early stages of cancer," the authors write in their report. They investigated the types of proteins secreted by these cells, and in the current study they looked for some of these proteins in the blood of patients with PDAC.

One protein, thrombospondin-2, was elevated in patients with PDAC. When combined with the already-identified cancer marker CA19-9, the researchers were even better at detecting these patients and discriminating between cancer stage. For instance, in a sample of 537 people, including PDAC patients, participants with other pancreatic disorders, and healthy individuals, the researchers demonstrated that thrombospondin-2 together with CA19-9 could pick out PDAC patients with 98 percent specificity and 87 percent sensitivity.


http://mobile.the-scientist.com/article/49896/study-blood-test-detects-pancreatic-cancer

Flu vaccine ineffective for people 65 and older last winter

The vaccine was about 42 percent effective in preventing illness severe enough to send a patient to the doctor's office. But it was essentially ineffective protecting some age groups. That includes people 65 and older — the group that's hardest hit by flu, suffering the most deaths and hospitalizations.

The flu season that just ended was a long one that peaked in February and was considered moderately severe. But the flu-related hospitalization rate for older adults was the highest it's been since the severe 2014-2015 flu season.

Like that season, last winter was dominated by a kind of flu — Type A H3N2 — that tends to cause more deaths and serious illnesses than other seasonal flu viruses.

In four of the last seven flu seasons, flu vaccine was essentially ineffective in seniors, past studies suggest. The worst performances tend to be in H3N2-dominant seasons.

Health officials say flu vaccine still protects many people. And even if fares poorly against the dominant virus, it can do a good job against other circulating flu strains.

"While it is clear we need better flu vaccines, it's important that we not lose sight of the important benefits of vaccination with currently available vaccines," said Jill Ferdinands, a flu epidemiologist at the Centers for Disease Control and Prevention, in a statement.

The CDC calculates vaccine effectiveness from a sample of flu tests done on patients in five states.

Vaccines against some other infectious diseases are not considered successful unless they are at least 90 percent effective. But flu is particularly challenging. Over the last ten winters, overall flu vaccine effectiveness has averaged about 46 percent.

Last winter's vaccine did well in protecting young children, about 60 percent effective. And it did OK in older children and in adults ages 50 to 64. But it had no clear effect in adults 18 to 49, or among the oldest adults.

Results were presented at a meeting in Atlanta of the Advisory Committee on Immunization Practices, which provides vaccine advice to the CDC.

https://apnews.com/e98a09e74e2343ad92cdea5beffc2888

Wednesday, July 12, 2017

Woman dies after contracting rare tick-borne virus | Fox News

The family of a Missouri woman who died from a rare tick-borne illness is speaking out about the dangers of the virus, which has only been confirmed in a handful of patients since it was discovered in 2014. Tamela Wilson, who died June 23 of complications stemming from Bourbon virus, had worked at Meramec State Park in Sullivan, and removed two ticks from her body a few weeks prior to falling ill, The St. Louis Post-Dispatch reported.

The 58-year-old woman's stepmother, Kathy Potter, said doctors didn't know to test for the disease, and diagnosed her with a urinary tract infection before sending her home with antibiotics.


http://www.foxnews.com/health/2017/07/12/woman-dies-after-contracting-rare-tick-borne-virus.html

Association of Changes in Diet Quality with Total and Cause-Specific Mortality — NEJM

Some epidemiologic studies of nutrition focus on dietary patterns rather than single nutrients or foods to evaluate the association between diet and health outcomes.1 Accumulated evidence supports an association between healthy dietary patterns and a decreased risk of death.2-11 Results from recent studies suggest that improved diet quality, as assessed by means of the Alternate Healthy Eating Index–2010 score,12 the Alternate Mediterranean Diet score,10,13 and the Dietary Approaches to Stop Hypertension (DASH) diet score,14 was associated with reductions of 8% to 22% in the risk of death from any cause15,16 and reductions of 19% to 28% in the risk of death from cardiovascular disease and 11% to 23% in the risk of death from cancer.2-4,17

Given such consistent evidence, the 2015 Dietary Guidelines for Americans recommended the Alternate Healthy Eating Index, the Alternate Mediterranean Diet, and DASH as practical, understandable, and actionable diet plans for the public.18 Such guidelines are important in the United States and globally because unhealthy diets have been ranked as a major factor contributing to death and health complications.19 Evaluation of changes in diet quality over time in relation to the subsequent risk of death would be important. Here, we evaluated the association between 12-year changes (from 1986 through 1998) in the three diet-quality scores noted above and the subsequent risk of total and cause-specific death from 1998 through 2010 among participants in the Nurses' Health Study and the Health Professionals Follow-up Study. We also examined short-term changes (baseline to 8-year follow-up, 1986–1994) and long-term changes (baseline to 16-year follow-up, 1986–2002) in diet quality in relation to total and cause-specific mortality.

http://www.nejm.org/doi/full/10.1056/NEJMoa1613502#article

Monday, July 10, 2017

Cardiovascular Disease Death Before Age 65 in 168 Countries Correlated Statistically

Paradoxes concerning CVD abound. Food scientists hotly dispute whether a plant-based diet or an omnivorous diet is optimal for the prevention of CVD [1]. Cardiologists debate whether the vulnerable plaque hypothesis to explain coronary artery disease (CAD) events, a foundational basis of lipid-lowering treatment, should be abandoned [2]. A recent trial showed that evacetrapib, a drug that lowers low-density lipoprotein (LDL) cholesterol, had no effect on the CVD outcomes, bringing into question the mechanism of the benefit of statins in reducing CVD events [3]. Counterintuitively, while the incidences of obesity and diabetes (i.e. risk factors for CVD) have risen during recent decades in Western countries, deaths attributed to CVD have fallen markedly [4].

Globally, about 30% of all deaths are due to CVD. About 38% of people in high-income countries die of CVD compared to 28% in low and middle-income countries [5]. However, CVD death rates among young people (< age 65) are higher in low and middle-income countries because of the shorter average lifespan. Nearly 80% of deaths in high-income countries occur among those over the age of 60 compared to 42% in low and middle-income countries [6]. These and the other CVD paradoxes call for new hypotheses that better explain the diverse and puzzling data. This paper will present data that supports the hypothesis that vitamin K2 (menaquinones: MK-4–MK-13) plays a central role in CVD etiology, epidemiology, and pathogenesis.

Vitamin K comprises a family of fat-soluble, structurally-similar compounds that function as enzymatic co-factors in the cross-linking of γ-carboxyl with ε-amino side chains in vitamin K-dependent proteins. Vitamin K-dependent proteins include not only blood coagulation proteins manufactured in the liver but also components of many extrahepatic tissues including arterial vessels and bones. Vitamin K1 (phylloquinone) comes primarily from green leafy vegetables. Vitamin K2 molecules are designated as MK-4–MK-13 according to the lengths of their isoprenyl side chains attached to a 2-methyl-1,4-naphthoquinone ring. Some vitamin K2 comes from dietary animal products without bacterial action (MK-4). Other vitamin K2 originates from bacterial action in animal and human guts and from bacterial action in fermenting plants and dairy products (MK-5–MK-13) [7]. In conjunction with vitamin D, vitamin K2 regulates the deposition of calcium, so bones and teeth receive calcium while blood vessels such as coronary arteries do not [8].

Animal trials and human observational studies have demonstrated that vitamin K2 deficiency (dietary deficiency or vitamin K inhibition by warfarin) contributes to CVD by stiffening and calcifying coronary arteries and other vessels [9]. An eight-year-long observational study involving 4,807 men and women aged 55 years and older in Rotterdam, Netherlands found that people in the lowest tertile of intake (vitamin K2 < 21.6 µg/day) had 27% more CVD mortality than people in the mid tertile (vitamin K2 = 21.6–32.7 µg/day) and 57% more than those in the upper tertile (vitamin K2 > 32.7 µg/day) [10]. As per the Multi-Ethnic Study of Atherosclerosis (MESA) in the United States, CVD incidence over 11 years of observation increased progressively as vitamin K2-dependent protein activity decreased, with event rates of 5.9 and 11.7 per 1000 person-years in the highest and lowest quartiles, respectively [11].

Biometric markers such as BMI, FBS, hemoglobin A1c, SBP, and serum cholesterol/HDL-cholesterol ratio (TC/HDL) have been correlated with CVD events in developed countries [12]. Socioeconomic risk factors such as dropping out of school, poverty, and certain occupations have also been correlated with CVD [13]. It has been found that nutritional and other stresses on infants and young children are associated with higher CVD death rates later in life. Study of infants in utero during the influenza pandemic of 1918 [14] and during the Dutch famine of 1944 [15] showed that these individuals suffered increased rates of CVD deaths in later life. Early childhood mortality (age 0–5 years) provides a reasonable index of fetal, infant, and early childhood distress (FICD) that might correlate with mortality from CVD in early adult life and middle age.

This study will use multiple regression analysis of female and male cohort data worldwide to relate early death from CVD (dependent variable) with major CVD risk factors (independent variables) to determine the attributable risks for each of these factors. For conditions associated with CVD (i.e. obesity, diabetes, hypertension, and increased TC/HDL), similar multiple regression analysis-derived formulae will be used to determine the attributable risks.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036986/